Esmolol does not improve quality of postsurgical recovery after ambulatory hysteroscopy: A prospective, randomized, double-blinded, placebo-controlled, clinical trial

A Comparative Study of the Effect of Labetalol and Remifentanil on Pain Control After Bariatric Surgery

Background

Finding the optimal combination of anesthetics to maintain hemodynamic stability during surgery can be challenging. Traditionally, strong opioid analgesics such as fentanyl and its newer analogs have been used. However, the use of narcotics is associated with certain side effects.

Objectives

This study compares the effects of labetalol and remifentanil in pain control after bariatric surgery in Hazrat Rasool Akram Hospital.

Methods

This randomized, double-blind clinical trial was conducted on 48 laparoscopic bariatric surgery patients. The participants were randomly divided into two groups receiving remifentanil or labetalol. Postoperative pain was measured in the recovery unit using the numerical rating scale (NRS). This score was recorded upon entering recovery, and 30 minutes, 60 minutes, and 120 minutes after surgery for each patient. Also, the duration of anesthesia, the duration of the operation, the recovery time, the dose of the administered opioids, the volume of intravenous fluids, and the dose of administered propofol were recorded for each patient. Nausea and vomiting after the operation were also recorded as outcomes.

Results

There were no significant differences between the two groups regarding the mean duration of surgery and anesthesia, dose of the administered anesthetics, recovery period, nausea and vomiting, and the dose of analgesics after the operation. The mean pain intensity during the given period and also the trend of pain intensity changes between the two groups demonstrated no statistically significant differences (P = 0.112). During the operation, 9 subjects (37.5%) in the labetalol group and 16 (66.7%) in the remifentanil group needed more analgesics (rescue drug); in this regard, a significant difference was observed between the two groups (P = 0.043).

Conclusions

Based on the study's findings, there were no significant differences between labetalol and remifentanil in post and perioperative pain control. However, rescue drugs needed to maintain hemodynamic stability during laparoscopic surgery were significantly lower in patients who received labetalol than remifentanil. Postoperative complications were also comparable between labetalol and remifentanil.

Comparison of electronic versus phone-based administration of the Quality of Recovery-40 survey after ambulatory surgery

STUDY OBJECTIVE

Studies that track patient-centered outcomes are better suited to evaluate the relative benefits and harms of an intervention in ambulatory surgery as severe morbidity and mortality have become increasingly rare. This pilot study aimed to assess for differences in response rate and survey scores for phone-based and electronic administration of the Quality of Recovery-40 (QoR-40) survey in patients undergoing general anesthesia for ambulatory surgery.

DESIGN

A single-center prospective observational study.

SETTING

Yale New Haven Hospital (September 22-November 2, 2021).

PATIENTS

100 consecutive patients undergoing ambulatory surgery under general anesthesia.

INTERVENTIONS

Patients were randomized to receive QoR-40 surveys via email or phone.

MEASUREMENTS

The QoR-40 survey is a 40-item questionnaire that provides a global score across five dimensions: patient support, comfort, emotions, physical independence, and pain. The primary outcome was the response rate following the administration of the QoR-40 survey on postoperative days 1, 2, and 7. The secondary outcome was the mean QoR-40 score during the study period.

MAIN RESULTS

A total of 109 patients consented to participate and 100 patients were randomized in this study. A total of 76%, 72%, and 68% of patients completed the survey on POD 1, 2, and 7, respectively. There were no differences in the response rate of patients who completed the survey between phone (78%) versus electronic (74%) administration (difference 4%, 95% confidence interval (CI): -13%, 21%, respectively) on POD 1, 2 (74% vs 70%, difference 4%, 95% CI -14%, 22%, respectively) or 7 (68% vs 68%, difference 0%, 95% CI -18%, 18%, respectively). The mean (standard deviation) QoR-40 score was 176.2 (18.1), 179.8 (19.4), 187.7 (13.1) on POD 1, 2, and 7, respectively. There were no significant differences in the mean QoR-40 scores between groups at any of the time points.

CONCLUSION

The response rate following the electronic administration of the QoR-40 survey did not differ from the phone-based administration during the postoperative period following ambulatory surgery. The use of an electronic version of the survey may allow for larger sample sizes with fewer resources utilized in future interventional studies.

Effects of the ultra-short-acting beta-blocker Esmolol infusion on cardiovascular parameters and quality of postoperative recovery in patients scheduled for elective plastic surgery

Background/Aim: Esmolol is an ultra-short-acting, easily titratable b-adrenergic receptor antagonist used for urgent treatment of hypertension and tachycardia in non-surgical and surgical settings. Aim of this clinical study was to investigate its cardiovascular effects and quality of the emergence from anaesthesia in patients scheduled for elective plastic surgery under general balanced anaesthesia. Methods: A total of 30 ASA I/II patients were randomised in two groups of similar demographic characteristics and baseline values of cardiovascular parameters. Esmolol group received esmolol dissolved in glucose 5 % as an intravenous infusion, 0.3 mg/kg/min during the first 5 min and at a rate of 0.1 mg/kg/ min thereafter. Control patients received the solvent only, at the same rate and volume. General balanced anaesthesia was induced with thiopentone sodium and fentanyl and maintained with nitrous oxide and oxygen. Neuromuscular relaxation was assured with pancuronium bromide and was antagonised at the end of operation with atropine and neostigmine. Systolic and diastolic blood pressure and heart rate were registered at all critical phases: (1) immediately prior to the induction (baseline value), (2) induction to anaesthesia, (3) tracheal intubation, (4) first skin incision, (5) surgical manipulation with organs, (6) suture of the surgical wound and (7) tracheal extubation. Drug consumption and quality of postoperative recovery were monitored. Results: In most of the critical phases of anaesthesia and operation, patients from the Esmolol group had significantly lower values of cardiovascular parameters than the patients from the Control group. Esmolol-treated patients needed less fentanyl, droperidol and pancuronium and had faster and smoother emergence from anaesthesia than the control patients. Conclusion: Esmolol improved haemodynamics and post-anaesthesia recovery in patients undergoing elective plastic surgery under general balanced anaesthesia.

Dexmedetomidine-remifentanil vs propofol-remifentanil for monitored anesthesia care during hysteroscopy: Randomized, single-blind, controlled trial

BACKGROUND

Although dexmedetomidine has been used as either the anesthetic agent for light sedation or as an adjunct to other sedatives, no study has investigated the usefulness of dexmedetomidine as the main sedative agent for invasive and painful procedures. The purpose of this study was to compare the safety of dexmedetomidine-remifentanil and propofol-remifentanil during monitored anesthesia care (MAC) for hysteroscopy.

METHODS

Female patients undergoing hysteroscopy were randomly assigned to either the dexmedetomidine (group D) or the propofol group (group P). The study drug (0.6 ml/kg; dexmedetomidine 2 μg/ml or propofol 4 mg/ml) was loaded for 10 minutes followed by 0.1 to 0.5 ml/kg/hour to maintain a bispectral index of 60 to 80 during the procedure. In both groups, remifentanil was infused using a target-controlled-infusion system with a target concentration of 2 ng/ml and titrated during the procedure. The incidence rates of intraoperative respiratory depression in both groups were compared. Postoperative pain and patients satisfaction were also compared.

RESULTS

A total of 69 female patients were included in this study. Dexmedetomidine significantly decrease the incidence of respiratory depression compared with propofol (15/34 [44.1%] vs 5/35 [14.3%], P = .006, group P and D, respectively). Postoperative pain and patients satisfaction score did not differ between the groups.

CONCLUSION

The combination of dexmedetomidine-remifentanil can reduce the incidence of respiratory depression without increasing hemodynamic complications compared with propofol-remifentanil for MAC during hysteroscopy.