ABSTRACT
The efficacy of intraoperatively administered ketorolac for the prophylactic treatment of pain in the postanesthesia care unit (PACU) was examined in a prospective, double-blinded study. Thirty patients undergoing general anesthesia for orthopedic or lower abdominal surgery were randomized into two groups. Both groups received equivalent doses of opioids intraoperatively. Upon surgical closure, one group received intramuscular (IM) ketorolac 60 mg (2 mL) and the other group received normal saline 2 mL, IM. The saline control group more frequently required opioid-analgesic supplementation in the PACU than did the ketorolac group (P < 0.05). Time to first-required opioid dose in the PACU was 22 +/- 8 versus 76 +/- 11 min for the control group and ketorolac group, respectively (P < 0.001). The ketorolac group reported significantly lower pain scores 1 hr after PACU admission (P < 0.01). Time to PACU discharge was not different between groups. Intraoperatively administered ketorolac is an effective adjunct in the management of postoperative pain.
Subject(s)
Anesthesia , Intraoperative Care , Pain, Postoperative/prevention & control , Tolmetin/analogs & derivatives , Adult , Analgesics/therapeutic use , Double-Blind Method , Female , Humans , Ketorolac , Male , Prospective Studies , Tolmetin/therapeutic useABSTRACT
Prolonged neuromuscular block occurs when suxamethonium is given after neostigmine or pyridostigmine; however, studies of edrophonium and suxamethonium have yielded conflicting results. We have studied, therefore, interactions between suxamethonium and all three anticholinesterases in rats anaesthetized with pentobarbitone. After recovery from an initial bolus of suxamethonium, saline, edrophonium, pyridostigmine or neostigmine was administered and a second dose of suxamethonium was then given. All three anticholinesterases prolonged the duration of neuromuscular block (90% suppression to 50% twitch recovery) to 127 (SEM 9)%, 127(10)% and 138 (11)% of baseline for edrophonium, pyridostigmine and neostigmine, respectively. Recovery index (25% to 75% twitch recovery) was increased also to 125 (9)%; 149 (10%) and 185 (15)% of baseline, respectively for the three drugs.
Subject(s)
Cholinesterase Inhibitors/pharmacology , Succinylcholine/antagonists & inhibitors , Animals , Drug Interactions , Edrophonium/pharmacology , Hindlimb , Male , Muscle Contraction/drug effects , Neostigmine/pharmacology , Pyridostigmine Bromide/pharmacology , Rats , Rats, Sprague-Dawley , Succinylcholine/pharmacology , Time FactorsABSTRACT
We modified a Bain circuit by placing the circuit into the Y piece of a standard carbon dioxide absorber circle, connecting the fresh gas hose on the anesthetic machine to the Bain's fresh gas inlet, and occluding the circle's fresh gas inlet. This circle-modified Bain breathing circuit was studied to evaluate whether it reduces fresh gas flow requirements. The Bain and modified Bain steady states were analyzed by mechanical and computer modeling. The mechanical model consisted of an artificial lung ventilated to steady state. Carbon dioxide was measured with capnography. Computer modeling was by compartmental analysis calculated with spread-sheet software. Steady-state solutions were obtained by numeric analysis. The circle-modified Bain greatly reduced retention of carbon dioxide. For example, with 1-liter tidal volumes, 10-liter minute volumes (10 breaths per minute), and a 2.1 L/min fresh gas flow, the steady-state end-tidal carbon dioxide values of the Bain and modified Bain were 9.3 and 4.6%, respectively, in the physical model (carbon dioxide inflow of 230 ml/min). Results from the mechanical model helped validate the computer model.
