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1.
J Surg Res ; 212: 122-129, 2017 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-28550898

RESUMO

BACKGROUND: The aim of this study was to compare postoperative pain outcomes between single-incision laparoscopic appendectomy (SILA) and conventional laparoscopic appendectomy (CLA) using a propensity score matching analysis. MATERIALS AND METHODS: Adult patients who underwent SILA or CLA for acute appendicitis between January 2010 and December 2015 at a single center were identified retrospectively from a prospectively collected database. All patients had used an intravenous patient-controlled analgesia (PCA) device for postoperative pain control. As potential confounding variables, patient characteristics and surgery-related, anesthesia-related, and PCA-related factors were collected from the database. The primary outcome was the postoperative pain score, and secondary outcomes were nausea, vomiting, rescue analgesic use, rescue antiemetic use, and PCA-related complications. These outcomes were compared between the SILA and CLA groups before and after 1:1 propensity score matching. RESULTS: From a total of 915 patients, 753 were selected: 116 in the SILA group and 637 in the CLA group. After propensity score matching, two comparable groups with 111 patients each were obtained. Pain score (P = 0.007) and rescue analgesic use (P = 0.043) on the day of surgery were significantly lower in the SILA group than in the CLA group. The other outcomes were similar between the two groups. CONCLUSIONS: SILA is a beneficial surgical procedure for postoperative pain management.


Assuntos
Apendicectomia/métodos , Apendicite/cirurgia , Laparoscopia/métodos , Dor Pós-Operatória/prevenção & controle , Adulto , Idoso , Analgesia Controlada pelo Paciente , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/tratamento farmacológico , Pontuação de Propensão , Estudos Retrospectivos , Resultado do Tratamento
2.
World J Surg ; 40(12): 2941-2947, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27379388

RESUMO

BACKGROUND: Systemic lidocaine has analgesic and anti-inflammatory effects. The purpose of this prospective, randomized, double-blind study was to evaluate the effects of intravenous lidocaine on pain following thyroidectomy. METHODS: Fifty-eight adult patients scheduled for total thyroidectomy were randomly allocated to receive a 1.5 mg/kg lidocaine bolus followed by a 2 mg/kg/h infusion during surgery, or the same volume of normal saline (control). After thyroidectomy, we evaluated postoperative pain, nausea, fentanyl consumption, frequency of pushing the button (FPB) for patient-controlled analgesia (PCA), High-sensitivity C-reactive protein (hs-CRP) in serum, and patient satisfaction scores regarding the recovery process. RESULTS: Postoperative pain and nausea scores were significantly lower in the lidocaine group for the first 4 h following thyroidectomy, compared to the control group. Fentanyl consumption and FPB for the PCA were also significantly reduced in the lidocaine group for 4 h following thyroidectomy, and hs-CRP was significantly less in the lidocaine group at postoperative days 1 and 3. Furthermore, satisfaction scores were significantly higher in the lidocaine group compared to the control group. CONCLUSIONS: Intravenous lidocaine effectively reduced postoperative pain and nausea following thyroidectomy as well as improved the quality of recovery. TRIAL REGISTRATION NUMBER: Clinicaltrials.gov NCT01608360.


Assuntos
Anestésicos Locais/administração & dosagem , Lidocaína/administração & dosagem , Náusea/tratamento farmacológico , Dor Pós-Operatória/tratamento farmacológico , Administração Intravenosa , Adolescente , Adulto , Idoso , Analgesia Controlada pelo Paciente , Analgésicos Opioides/uso terapêutico , Proteína C-Reativa/metabolismo , Método Duplo-Cego , Feminino , Fentanila/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Náusea/etiologia , Medição da Dor , Dor Pós-Operatória/etiologia , Satisfação do Paciente , Estudos Prospectivos , Tireoidectomia/efeitos adversos , Adulto Jovem
3.
BMC Anesthesiol ; 14: 68, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25165427

RESUMO

BACKGROUND: Postoperative nausea and vomiting (PONV) is one of the most common postsurgical complications. Palonosetron, a 5-hydroxytryptamine receptor antagonist, is effective for PONV prevention. Herein, we compared palonosetron and aprepitant (a neurokinin-1 receptor antagonist) for PONV prevention in patients indicated for laparoscopic gynaecologic surgery. METHODS: Ninety-three patients who were scheduled to undergo laparoscopic gynaecologic surgery under general anaesthesia were assigned to receive either a single intravenous injection of 0.075-mg palonosetron or 40-mg oral aprepitant in a double-blind randomised trial. The primary efficacy end points included complete response (visual analogue scale [VAS] nausea score <4 and no use of rescue therapy) 0-48 h after surgery. Nausea severity (0-10) and use of rescue therapy were monitored for 0-48 h. The secondary efficacy end points were the effect of aprepitant quantified using a 10-point VAS for pain, consumption of intravenous patient-controlled analgesia, and use of rescue analgesics. RESULTS: Aprepitant was non-inferior to palonosetron in terms of complete response 0-48 hours after surgery (74% vs. 77%). At 0 and 2 h after administration, the nausea severity with 40-mg aprepitant was significantly lesser than that with 0.075-mg palonosetron (P < 0.05). At 6 and 24 h after administration, fentanyl consumption with 40-mg aprepitant was significantly lower than that with 0.075-mg palonosetron. Greater amounts of rescue analgesics were required in the aprepitant group. CONCLUSIONS: Palonosetron and aprepitant were both effective for PONV prevention in the patients indicated for laparoscopic gynaecologic surgery. The drugs can be used in combination for multimodal therapy because they bind to different receptors. More research is needed to evaluate the effects of aprepitant on pain management in humans.


Assuntos
Antieméticos/uso terapêutico , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Isoquinolinas/uso terapêutico , Laparoscopia/efeitos adversos , Morfolinas/uso terapêutico , Náusea e Vômito Pós-Operatórios/prevenção & controle , Quinuclidinas/uso terapêutico , Adulto , Analgesia Controlada pelo Paciente , Aprepitanto , Método Duplo-Cego , Feminino , Humanos , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/prevenção & controle , Palonossetrom , Adulto Jovem
4.
Korean J Anesthesiol ; 66(2): 105-11, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24624267

RESUMO

BACKGROUND: This study was designed to find appropriate lubricant for streamed lined liner of pharyngeal airway™ (SLIPA™). We evaluated the incidence of sore throat, nausea, vomiting, hoarseness, paresthesia and blood stain after using saline, water soluble gel and 2% lidocaine gel as a SLIPA™ lublicant. METHODS: One hundred twenty three patients scheduled for minor surgery to whom the SLIPA™ was considered suitable were randomly allocated to one of three groups which receive normal saline, water soluble gel or 2% lidocaine gel as a SLIPA™ lublicant. Patients were interviewed at recovery room, post operation 6-12 hour, post operation 18-24 hour about sore throat and other complications. RESULTS: There were no statistical difference in sore throat and blood stain among three groups. Also there were no statistical differences in hoarseness, nausea, vomiting. The incidence of paresthesia in 2% lidocaine gel group was significantly higher than those of the other two groups immediately after operation, but it was resolved after leaving the recovery room. CONCLUSIONS: Our results suggest that normal saline, water soluble gel and 2% lidocaine gel are all available as a SLIPA™ lubricant. Size of SLIPA™, insertion technique and difficulty of insertion should be further investigated as the main causes of a sore throat and other complications which can occur after the insertion of SLIPA™.

5.
J Surg Res ; 187(1): 169-75, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24555878

RESUMO

BACKGROUND: The aim of this study was to assess whether intraperitoneal administration of ginseng total saponins (GTS) has antihyperalgesic effects in a rat model of incisional pain. The proinflammatory responses and reversal of the antihyperalgesic effect of GTS by N-methyl-d-aspartate (NMDA) or naloxone were also evaluated. MATERIALS AND METHODS: Rats were injected intraperitoneally with 0.9% saline vehicle or various doses of GTS before or after a plantar incision. Paw withdrawal in response to application of the von Frey filament with the lowest bending force marked the mechanical withdrawal threshold (MWT). Blood samples were collected for the assessment of serum interleukin (IL)-1ß and IL-6 levels. The IL levels were measured using an enzyme-linked immunosorbent assay kit. Rats were injected intraperitoneally with NMDA or naloxone before the GTS injection to assess the reversal of the antihyperalgesic effect of GTS. RESULTS: The MWT measured 2 h after the plantar incision increased significantly after the postincision administration of 50, 100, or 200 mg/kg of GTS compared with the MWT at 2 h after plantar incision. The MWT also increased significantly after the preincision injection of 100 or 200 mg/kg of GTS compared with the MWT of the vehicle control. Administration of GTS suppressed the postincision rise in serum IL-1ß levels and NMDA inhibited the increase in the MWT compared with GTS alone. CONCLUSIONS: Intraperitoneal administration of GTS before or after surgery induces antihyperalgesic effects in a rat model of incisional pain. The effects on mechanical hyperalgesia may be associated with anti-inflammatory cytokines and NMDA signaling.


Assuntos
Dor Aguda/tratamento farmacológico , Hiperalgesia/tratamento farmacológico , Dor Pós-Operatória/tratamento farmacológico , Panax/química , Saponinas/farmacologia , Animais , Modelos Animais de Doenças , Agonistas de Aminoácidos Excitatórios/farmacologia , Injeções Intraperitoneais , Masculino , N-Metilaspartato/farmacologia , Naloxona/farmacologia , Antagonistas de Entorpecentes/farmacologia , Ratos , Ratos Sprague-Dawley
6.
J Int Med Res ; 41(4): 1203-13, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23766412

RESUMO

OBJECTIVE: To compare the efficacy of ramosetron, midazolam, and the combination of ramosetron and midazolam in the prevention of postoperative nausea and vomiting (PONV) in female patients undergoing thyroidectomy. METHODS: Patients were randomized to receive 0.3 mg ramosetron (Group R), 75 µg/kg midazolam (Group M) or 0.3 mg ramosetron combined with 75 µg/kg midazolam (Group RM) before the induction of anaesthesia. PONV, use of rescue antiemetics, pain severity and fentanyl consumption were assessed for 24 h after thyroidectomy. RESULTS: A total of 100 patients were enrolled; 94 patients completed the study. The severity of nausea was statistically significantly reduced at 0-2 h in Group RM compared with Groups R and M, and at 2-6 h in Group RM compared with Group M. The incidence of retching and vomiting was significantly lower at 0-2 h, 2-6 h, 6-12 h in Group RM than in Group M, and lower in Group R than Group M at 6-12 h. The requirement for rescue antiemetics was significantly lower at 0-2 h in group RM than in group M. CONCLUSION: The combination therapy of ramosetron and midazolam provided superior antiemetic efficacy compared with midazolam single therapy, but did not show any significant additional benefits compared with ramosetron single therapy.


Assuntos
Antieméticos/uso terapêutico , Benzimidazóis/uso terapêutico , Midazolam/uso terapêutico , Náusea e Vômito Pós-Operatórios/prevenção & controle , Tireoidectomia , Adulto , Analgésicos Opioides/efeitos adversos , Método Duplo-Cego , Esquema de Medicação , Quimioterapia Combinada , Feminino , Fentanila/efeitos adversos , Humanos , Pessoa de Meia-Idade , Náusea e Vômito Pós-Operatórios/induzido quimicamente , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento
7.
Korean J Anesthesiol ; 64(4): 308-14, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23646239

RESUMO

BACKGROUND: We studied the differences in airway assessment factors among old, middle, and young age groups, and evaluated the frequency and causes of difficult intubation among these groups. METHODS: Patients were divided into young (< 40 yr, n = 75 ), middle (40-59 yr, n = 83), and old (≥ 60 yr, n = 89) group. Airway assessment factors such as head and neck movement, thyromental distance, interincisor gap, dentition, Mallampati score, and Arné score were assessed. After muscle relaxation, cervical joint rigidity and Cormack-Lehane (C-L) grade were assessed. The differences in airway assessment factors between difficult (C-L grade 3, 4) and easy (C-L grade 1, 2) intubation were then examined. Logistic regression analysis was also carried out to identify the extent to which airway assessment factors reflected difficult intubation. RESULTS: As aging, head and neck movement, thyromental distance, and interincisor gap decreased, the grade of dentition, Mallampati score, cervical joint rigidity and the ratio of Arné score > 11 increased. In the old and middle group, the incidence of difficult intubation was increased compared with the young group. Dentition in the young group, Mallampati score and interinsisor gap in the middle group and Mallampati score, cervical joint rigidity in the old group respectively predicted difficult intubation. CONCLUSIONS: Compared to young individuals, middle-aged or elderly adults are likely to experience more difficulty in endotracheal intubation and its predictive factors could vary by age group.

8.
Korean J Pain ; 26(1): 62-4, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23342210

RESUMO

Hemifacial spasm is defined as unilateral, involuntary, irregular twitching of all or parts of the muscles innervated by facial nerves. Here, we present a case of recurrent hemifacial spasm after microvascular decompression (MVD) treated with pulsed radiofrequency (PRF) treatment with good results. A 35-year-old woman suffered from recurrent hemifacial spasm after MVD that was refractory to medical treatment and botulinum toxin injections. We attempted a left facial nerve block twice. Then, we applied PRF at a maximum temperature of 42℃ for 120 sec. Some response was observed, so we applied PRF two additional times. The frequency of twitch decreased from 3-4 Hz to < 0.5 Hz, and subjective severity on a visual analogue scale also decreased from 10/10 to 2-3/10. PRF treatment might be an effective medical treatment for refractory hemifacial spasm and has fewer complications and is less invasive compared with those of surgery.

9.
Korean J Pain ; 26(1): 84-8, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23342215

RESUMO

A 60-year-old man presented with pain on the left cheek and lateral nose. The patient had been diagnosed with facial herpes zoster in the left V2 area 6 months previously. Medical treatment was prescribed for 6 months but it had little effect. We blocked the left infraorbital nerve under ultrasound guidance, but pain relief was short term. Therefore, we performed pulsed radiofrequency treatment on the left infraorbital nerve under ultrasound guidance. Six months after the procedure, the reduction of pain was still maintained, and there was no need for further management.

10.
J Bone Joint Surg Am ; 95(4): 291-6, 2013 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-23302898

RESUMO

BACKGROUND: Appropriate pain management affects outcome after hip fracture surgery. Although multimodal pain management is commonly used for pain control for patients undergoing elective surgery, few studies have evaluated its use in those undergoing hip fracture surgery. This prospective randomized study was designed to determine the clinical value of multimodal pain management with preemptive pain medication and intraoperative periarticular multimodal drug injections in patients undergoing bipolar hip hemiarthroplasty. METHODS: Of eighty-two cognitively intact elderly patients about to undergo bipolar hemiarthroplasty after a hip fracture, forty-three were randomly assigned to receive preemptive pain medication and intraoperative periarticular injections (Group I) and thirty-nine were assigned to not receive preemptive medication and injections (Group II). These two groups were compared with regard to the pain level on postoperative days one, four, and seven; at discharge; and when they started walking and standing exercises. Total amounts of fentanyl used, the frequency of use of patient-controlled analgesia, patient satisfaction at discharge, and perioperative complications were recorded. RESULTS: Group I had a lower pain level than Group II on postoperative days one and four, but no intergroup difference in pain level was observed on postoperative day seven. The total amount of fentanyl used and the frequency of use of patient-controlled analgesia were also lower in Group I. Patient satisfaction at discharge was higher in Group I. No significant intergroup differences were found in the times until the patients walked or performed standing exercises or in the complications. CONCLUSIONS: Multimodal pain management provides additional pain relief until the fourth postoperative day, improves patient satisfaction at discharge, and reduces total narcotic consumption for postoperative pain management after hip hemiarthroplasty for hip fractures.


Assuntos
Analgésicos Opioides/uso terapêutico , Artroplastia de Quadril/métodos , Fentanila/uso terapêutico , Fraturas do Quadril/cirurgia , Manejo da Dor/métodos , Dor Pós-Operatória/tratamento farmacológico , Agonistas alfa-Adrenérgicos/administração & dosagem , Agonistas alfa-Adrenérgicos/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Amidas/administração & dosagem , Amidas/uso terapêutico , Analgesia Controlada pelo Paciente , Analgésicos Opioides/administração & dosagem , Anestésicos Locais/administração & dosagem , Anestésicos Locais/uso terapêutico , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Anti-Inflamatórios não Esteroides/administração & dosagem , Anti-Inflamatórios não Esteroides/uso terapêutico , Cefmetazol/administração & dosagem , Cefmetazol/uso terapêutico , Celecoxib , Distribuição de Qui-Quadrado , Inibidores de Ciclo-Oxigenase 2/administração & dosagem , Inibidores de Ciclo-Oxigenase 2/uso terapêutico , Quimioterapia Combinada , Epinefrina/administração & dosagem , Epinefrina/uso terapêutico , Feminino , Fentanila/administração & dosagem , Humanos , Injeções Intra-Articulares , Cetorolaco/administração & dosagem , Cetorolaco/uso terapêutico , Masculino , Morfina/administração & dosagem , Morfina/uso terapêutico , Oxicodona/administração & dosagem , Oxicodona/uso terapêutico , Medição da Dor , Satisfação do Paciente , Estudos Prospectivos , Pirazóis/administração & dosagem , Pirazóis/uso terapêutico , Ropivacaina , Método Simples-Cego , Estatísticas não Paramétricas , Sulfonamidas/administração & dosagem , Sulfonamidas/uso terapêutico , Resultado do Tratamento
11.
Korean J Anesthesiol ; 63(5): 419-24, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-23198035

RESUMO

BACKGROUND: This study was designed to assess the effects of pneumoperitoneal pressure (PP) and positional changes on the respiratory mechanics during laparoscopy assisted colectomy. METHODS: Peak inspiratory pressure, plateau pressure, lung compliance, and airway resistance were recorded in PP of 10 mmHg and 15 mmHg, with the position change in 5 steps: head-down at 20°, head-down at 10°, neutral position, head-up at 10° and head-up at 20°. RESULTS: When the patient was placed head-down, the position change accentuated the effects of pneumoperitoneum on respiratory mechanics. However, when the patient was placed in a head-up position during pneumoperitoneum the results showed no pattern. In the 20° head-up position with the PP being 10 mmHg, the compliance increased from 30.6 to 32.6 ml/cmH(2)O compared with neutral position (P = 0.002). However with the PP being 15 mmHg, the compliance had not changed compared with neutral position (P = 0.989). In 20° head-down position with the PP of 10 mmHg, the compliance was measured as 24.2 ml/cmH(2)O. This was higher than that for patients in the 10° head-down position with a PP of 15 mmHg, which was recorded as 21.2 ml/cmH(2)O. Also in the airway resistance, the patient in the 20° head-down position with the PP of 10 mmHg showed 15.8 cmH(2)O/L/sec, while the patient in the 10° head-down position with the PP of 15 mmHg showed 16.2 cmH(2)O/L/sec of airway resistance. These results were not statistically significant but still suggested that the head-down position accentuated the effects of pneumoperitoneum on respiratory mechanics. CONCLUSIONS: Our results suggest that respiratory mechanics are affected by the patient position and the level of PP - the latter having greater effect.

12.
Korean J Anesthesiol ; 63(2): 130-5, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22949980

RESUMO

BACKGROUND: Optiscope™ is a newly developed video stylet device. This study evaluated and compared the hemodynamic changes observed after endotracheal intubation with video stylet and after conventional laryngoscopic endotracheal intubation. METHODS: Fifty-eight adult patients with American Society of Anesthesiologists (ASA) physical status class 1 or 2, undergoing general anesthesia, were randomized into two groups: one group of patients were intubated using video stylet (n = 29) and the other group were intubated using direct laryngoscope (n = 29). Systolic blood pressure (SBP), mean arterial pressure (MAP), diastolic blood pressure (DBP), heart rate (HR), POGO (percentage of glottic opening) score, time for intubation and degree of sore throat were recorded. RESULTS: There were no significant differences in the SBP, MAP, DBP, HR, and the sore throat incidence between the two groups. Optiscope™ produced better POGO scores, but time for intubation was longer than with conventional laryngoscope. CONCLUSIONS: Optiscope™, when compared with conventional laryngoscope for intubation, does not modify the hemodynamic response, but it provides a better view of the vocal cords.

13.
Korean J Anesthesiol ; 63(2): 173-6, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22949988

RESUMO

Seizure associated with antiemetics is rare. We report seizure associated with a 5-HT(3) receptor antagonist in a 38 years old female. The patient underwent ureterorenoscopic lithotripsy due to left upper ureter stone. After operation, the patient complained of nausea in the postanesthetic recovery unit. In order to subside symptom, the patient was administrated 5-HT(3) receptor antagonist, palonosetron, 0.075 mg intravenously. Shortly after administration of that, the patient developed generalized tonic-clonic seizures. The symptom was subsided after midazolam and thiopental sodium were injected. But 40 minutes later, seizure recurred and subsided with midazolam again. The patient recovered completely without any specific sequelae.

14.
Korean J Anesthesiol ; 62(5): 441-7, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22679541

RESUMO

BACKGROUND: In the midthoracic region, a fluroscope guided epidural block has been proposed by using a pedicle as a landmark to show the height of the interlaminar space (Nagaro's method). However, clinical implication of this method was not fully evaluated. We studied the clinical usefulness of a fluoroscope guided thoracic epidural block in the midthoracic region. METHODS: Twenty four patients were scheduled to receive an epidural block at the T6-7 intervertebral space. The patients were placed in the prone position. The needle entry point was located at the junction between midline of the pedicle paralleled to the midline of the T7 vertebral body (VB) and the lower border of T7 VB on anteroposterior view of the fluoroscope. The needle touched and walked up the lamina, and the interlaminar space (ILS) was sought near the midline of the VB at the height of the pedicle. RESULTS: The authors could not insert an epidural needle at T6-7 ILS in two patients and it was instead inserted at T5-6 ILS. However, other patients showed easy insertion at T6-7 ILS. The mean inward and upward angulations were 25° and 55° respectively. The mean actual depth and calculated depth from skin to thoracic epidural space were 5.1 cm and 6.1 cm respectively. Significant correlation between actual needle depth and body weight, podendal index (kg/m) or calculated needle depth was noted. CONCLUSIONS: The fluorposcope guided epidural block by Nagaro's method was useful in the midthoracic region. However, further study for the caudal shift of needle entry point may be needed.

15.
Korean J Anesthesiol ; 62(4): 343-9, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22558501

RESUMO

BACKGROUND: We made a comparative study on the antiemetic effect of midazolam and ondansetron added to intravenous patient-controlled analgesia (PCA) using fentanyl with gynecologic patients undergoing pelviscopic surgery. METHODS: The PCA using 20 µg/kg of fentanyl was started in all groups postoperatively. A dose of 16 mg of ondansetron was added to the PCA of group O (n = 30). A dose of 5 mg of midazolam was added to the PCA of group M (n = 30). While 16 mg of ondansetron and 5 mg of midazolam were added to the PCA of group MO (n = 30). Total volume of the PCA was 60 ml, and the PCA system was programmed to deliver 0.5 ml/h of continuous doses and a 0.5 ml bolus on demand, with a 15 minutes lockout interval. The incidence of postoperative nausea and vomiting (PONV), sedation score, visual analog scale (VAS) for pain, and rescue drug dose for PONV were investigated at the postanesthesia care unit (PACU), 6 hours, and 24 hours after recovery. RESULTS: The incidence of PONV in group MO was significantly lower than in group O at PACU, 24 hours after recovery (P < 0.05). The sedation score and VAS pain score showed no differences among all groups. CONCLUSIONS: Midazolam added to PCA using fentanyl proved more effective than ondansetron in preventing PONV without adverse effects.

16.
J Clin Anesth ; 23(8): 649-52, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22137519

RESUMO

A case of severe hyponatremia with accompanying pulmonary edema and cardiovascular instability during a hysteroscopic myomectomy with general anesthesia is presented. The patient's sodium value decreased to 87 mmol/L. She was managed with aggressive maneuvers, including an infusion of 3% hypertonic saline. The patient's serum sodium increased to 113 mmol/L at the end of the operation, and it was increased up to 138 mmol/L at 48 hours. The patient recovered completely without neurologic sequelae.


Assuntos
Hiponatremia/etiologia , Histeroscopia/métodos , Leiomioma/cirurgia , Irrigação Terapêutica/efeitos adversos , Adulto , Anestesia Geral/métodos , Doenças Cardiovasculares/etiologia , Feminino , Humanos , Hiponatremia/fisiopatologia , Complicações Intraoperatórias , Edema Pulmonar/etiologia , Solução Salina Hipertônica/uso terapêutico , Índice de Gravidade de Doença , Sódio/sangue , Irrigação Terapêutica/métodos , Neoplasias Uterinas/cirurgia
17.
Surg Endosc ; 25(10): 3183-90, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21487863

RESUMO

BACKGROUND: The preemptive intravenous and intraperitoneal application of local anesthetics is known to improve the postoperative outcome in abdominal surgery. The aim of this study was to compare the analgesic effect of intravenous lidocaine injection to that of intraperitoneal lidocaine instillation in patients who were undergoing laparoscopic appendectomy (LA). METHOD: Sixty-eight patients who were undergoing LA for unperforated appendicitis were randomly divided into three groups. Group IP (the intraperitoneal instillation group) received intraperitoneal instillation of lidocaine and intravenous normal saline injection. Group IV (the intravenous injection group) received intravenous lidocaine injection and intraperitoneal instillation of normal saline. In group C (the placebo control group), normal saline was given both intravenously and intraperitoneally. The visual analog scale (VAS) of pain scores was measured after surgery. The needs for additional intravenous fentanyl were evaluated and the integrated fentanyl consumption (PCA delivered + additional fentanyl) was assessed. The incidence of shoulder tip pain and postoperative nausea and vomiting (PONV) were noted. RESULTS: Reduction of the VAS score and of fentanyl consumption was noted in the IV and IP groups and compared to that of group C (P < 0.05). The shoulder tip pain and PONV were reduced in groups IP and IV compared to that in group C (P < 0.05). However, no significant differences were found between the IP and IV groups for all the studied variables. There was no adverse effect from intravenous lidocaine throughout the study. CONCLUSION: Intravenous lidocaine injection is as effective as intraperitoneal instillation for reducing pain and fentanyl consumption. The major benefit of intravenous injection is that this is an easily and universally applicable procedure compared to that of intraperitoneal instillation. Lidocaine intravenous administration is a better alternative for reducing the pain of patients who are undergoing laparoscopic surgery.


Assuntos
Anestésicos Locais/administração & dosagem , Apendicectomia/métodos , Laparoscopia/métodos , Lidocaína/administração & dosagem , Dor Pós-Operatória/prevenção & controle , Adolescente , Adulto , Idoso , Distribuição de Qui-Quadrado , Método Duplo-Cego , Feminino , Humanos , Incidência , Injeções Intraperitoneais , Injeções Intravenosas , Instilação de Medicamentos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/epidemiologia , Placebos , Náusea e Vômito Pós-Operatórios/epidemiologia , Estudos Prospectivos , Estatísticas não Paramétricas
18.
Can J Anaesth ; 58(1): 48-54, 2011 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-21042901

RESUMO

PURPOSE: The aim of this study was to compare the Streamlined Liner of the Pharynx Airway (SLIPA™) with the ProSeal Laryngeal Mask Airway (LMA-ProSeal™) in mechanically ventilated paralyzed patients undergoing laparoscopic gynecologic surgery. METHODS: One hundred and one patients were allocated randomly to SLIPA (n = 50) or to LMA-ProSeal (n = 51) treatment groups. After induction of general anesthesia and insertion of the assigned supralaryngeal airway (SLA) device, we made note of the occurrence of any gastric insufflation and perilaryngeal leakage. We then evaluated the anatomical fit of the SLA device using a fibreoptic bronchoscope, and we assessed the airway sealing pressure and respiratory mechanics with change in head position and during peritoneal insufflation. After surgery, we evaluated the severity of postoperative sore throat and the presence of blood or regurgitated fluid on the SLA device. RESULTS: The insertion success rate, gastric insufflation, perilaryngeal leakage, anatomical fit, airway sealing pressure, respiratory mechanics, severity of sore throat, and incidence of blood and regurgitated fluid on the device were similar between the two groups. The incidence of perilaryngeal leakage with changes in the patient's head position was lower with the SLIPA group than with the LMA-ProSeal group (3/50 vs 11/51, respectively; P = 0.026). During peritoneal insufflation, perilaryngeal leakage did not occur with the SLIPA but occurred in four cases with the LMA-ProSeal (P = 0.045). CONCLUSION: Both the SLIPA and the LMA-ProSeal can be used effectively and without severe complications in paralyzed patients undergoing laparoscopic gynecological surgery. However, the SLIPA offers the advantage of less perilaryngeal gas leakage than the LMA-ProSeal with change in head position and during insufflation of the peritoneal cavity. This trial is registered with ANZCTR (ACTRN12609000914268).


Assuntos
Laparoscopia/métodos , Máscaras Laríngeas/efeitos adversos , Paralisia/complicações , Complicações Pós-Operatórias/etiologia , Adulto , Broncoscopia/métodos , Desenho de Equipamento , Falha de Equipamento , Feminino , Tecnologia de Fibra Óptica , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Pessoa de Meia-Idade , Cavidade Peritoneal , Faringite/etiologia , Postura , Respiração Artificial , Mecânica Respiratória , Índice de Gravidade de Doença , Adulto Jovem
19.
J Surg Res ; 171(1): 94-100, 2011 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-20605604

RESUMO

BACKGROUND: Although laparoscopic procedures are becoming more common, postoperative pain remains a major factor causing delayed patient recovery. There have been several trials to reduce pain by instilling local anesthetics into the peritoneal cavity, but there has been no study on prolonged (∼300 min) or intensive surgery. We investigated the analgesic effect of intraperitoneal ropivacaine instillation after laparoscopic colectomy. MATERIALS AND METHODS: Sixty patients were randomized to three groups. Twenty patients in each group received 50 mL of appropriate solutions after the formation of a pneumoperitoneum. The solution was normal saline (control) in group C and 1 mg/kg of ropivacaine in each of groups I and D. In group D, ropivacaine was sprayed again before the elimination of the pneumoperitoneum. Patients reported their postoperative pain using a subjective visual analogue scale. Fentanyl use for pain relief and frequency of pushing a button (FPB) for a bolus of patient controlled analgesia were evaluated, and scales of recovery rates were obtained. RESULTS: The immediate postoperative pain score was lower in groups I and D than in group C. In groups I and D, FPB measures and fentanyl use were both less than in group C. The time taken to resume a regular diet was shorter in group D than in group C. CONCLUSIONS: The intraperitoneal instillation of ropivacaine was effective in reducing postoperative pain and in shortening the recovery course after laparoscopic colectomy. The additional instillation of ropivacaine at the end of the surgery proved even more effective.


Assuntos
Amidas/administração & dosagem , Anestésicos Locais/administração & dosagem , Colectomia , Laparoscopia , Dor Pós-Operatória/tratamento farmacológico , Adulto , Idoso , Analgésicos Opioides/administração & dosagem , Fentanila/administração & dosagem , Humanos , Injeções Intraperitoneais , Pessoa de Meia-Idade , Pneumoperitônio Artificial , Estudos Prospectivos , Ropivacaina , Fatores de Tempo , Resultado do Tratamento
20.
Acta Med Okayama ; 64(5): 307-16, 2010 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-20975764

RESUMO

It is not known whether changing from isoflurane to desflurane during the latter part of anesthesia shows early emergence and recovery in long surgery. We therefore evaluated the effects of changing isoflurane to desflurane on emergence and recovery. Eighty-two patients were randomly assigned to receive isoflurane (Group I) or desflurane (Group D) or to change from isoflurane to desflurane anesthesia (Group X). At the point when there was an hour until the operation would end, isoflurane was replaced with 1 MAC of desflurane in Group X, and isoflurane and desflurane were maintained at 1 MAC in Groups I and D. When the operation ended, we compared the emergence and recovery characteristics among the 3 groups. Compared with Group I, Group X showed faster emergence and recovery. Group X and Group D showed similar emergence and recovery. In conclusion, changing isoflurane to desflurane during the latter part of anesthesia improves emergence and recovery.


Assuntos
Período de Recuperação da Anestesia , Isoflurano/análogos & derivados , Isoflurano/administração & dosagem , Adolescente , Adulto , Idoso , Anestésicos Inalatórios , Desflurano , Feminino , Humanos , Laparotomia/métodos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Adulto Jovem
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