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Lin PJ, Lin LS, Chung CS. Intranasal dexmedetomidine as premedication for magnetic resonance imaging examinations in dogs with neurological disorders mitigates hypotension and hypothermia. J Am Vet Med Assoc 2024; 262:193-200. [PMID: 37879359 DOI: 10.2460/javma.23.06.0322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 09/26/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVE This study aimed to evaluate the safety and feasibility of intranasal administration of dexmedetomidine as a premedication for preventing hypotension and hypothermia in canine patients undergoing MRI examinations. ANIMALS Dogs undergoing MRI examinations for neurological disorders were enrolled in this study. The dogs were randomly assigned: 15 to the N-Dex group (without premedication) and 13 to the Dex group (125 μg/m2 of dexmedetomidine, intranasally, as a premedication). METHODS During the examination, pulse rate, systolic blood pressure, diastolic blood pressure, and mean arterial blood pressure were recorded every 5 minutes for the first 30 minutes. Body temperature was measured before and after the examination. Any adverse events during the procedure were documented. RESULTS Significant changes in pulse rate during the examination were not distinguishable. Although blood pressure and body temperature decreased in both groups under anesthesia, dogs in the Dex group had a significantly smaller drop in blood pressure and body temperature and fewer hypotension events than those in the N-Dex group MRI examinations of 1 hour's duration. Two dogs in the Dex group exhibited bradycardia at 45 and 60 minutes of MRI examination, which resolved after receiving atipamezole. CLINICAL RELEVANCE Our results indicate that intranasal administration of 125 μg/m2 of dexmedetomidine as premedication is safe and can potentially mitigate hypothermia and hypotension in dogs with neurological disorders during MRI examinations.
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Affiliation(s)
- Pei-Jyuan Lin
- 1Veterinary Medical Teaching Hospital, National Pingtung University of Science and Technology, Pingtung, Taiwan
| | - Lee-Shuan Lin
- 1Veterinary Medical Teaching Hospital, National Pingtung University of Science and Technology, Pingtung, Taiwan
- 2School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- 3Department of Medical Imaging and Radiological Sciences, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
- 4UniCore Animal Hospital, Taipei City, Taiwan
- 5Department of Veterinary Medicine, College of Veterinary Medicine, National Pingtung University of Science and Technology, Pingtung, Taiwan
| | - Cheng-Shu Chung
- 1Veterinary Medical Teaching Hospital, National Pingtung University of Science and Technology, Pingtung, Taiwan
- 4UniCore Animal Hospital, Taipei City, Taiwan
- 5Department of Veterinary Medicine, College of Veterinary Medicine, National Pingtung University of Science and Technology, Pingtung, Taiwan
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Jao ME, Indorf AL, Segal EM, Miske A, Eaton KD, Marsolini T, Ghuman S. Impact of institutional interventions on the rate of paclitaxel hypersensitivity reactions. J Oncol Pharm Pract 2024; 30:105-111. [PMID: 37021579 DOI: 10.1177/10781552231168594] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
PURPOSE Paclitaxel is associated with hypersensitivity reactions (HSRs). Intravenous premedication regimens have been devised to decrease the incidence and severity of HSRs. At our institution oral histamine 1 receptor antagonists (H1RA) and histamine 2 receptor antagonists (H2RA) were adopted as standard. Standardizations were implemented for consistent premedication use in all disease states. The purpose of this retrospective study was to compare the incidence and severity of HSRs before and after standardization. METHODS Patients who received paclitaxel from 20 April 2018 to 8 December 2020 having an HSR were included in analysis. An infusion was flagged for review if a rescue medication was administered after the start of the paclitaxel infusion. The incidences of all HSR prior to and post-standardization were compared. A subgroup analysis of patients receiving paclitaxel for the first and second time was performed. RESULTS There were 3499infusions in the pre-standardization group and 1159infusions in the post-standardization group. After review, 100 HSRs pre-standardization and 38 HSRs post-standardization were confirmed reactions. The rate of overall HSRs was 2.9% in the pre-standardization group and 3.3% in the post-standardization group (p = 0.48). HSRs, during the first and second doses of paclitaxel, occurred in 10.2% of the pre-standardization and 8.5% of the post-standardization group (p = 0.55). CONCLUSIONS This retrospective interventional study demonstrated that same-day intravenous dexamethasone, oral H1RA, and oral H2RA are safe premedication regimens for paclitaxel. No change in the severity of reactions was seen. Overall, better adherence to premedication administration was seen post-standardization.
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Affiliation(s)
- Mark Edward Jao
- Department of Pharmacy, Fred Hutch Cancer Center, Seattle, WA, USA
| | - Amy Ly Indorf
- Department of Pharmacy, Fred Hutch Cancer Center, Seattle, WA, USA
| | | | - Abby Miske
- Department of Pharmacy, Fred Hutch Cancer Center, Seattle, WA, USA
| | | | - Trisha Marsolini
- Department of Pharmacy, Fred Hutch Cancer Center, Seattle, WA, USA
| | - Simran Ghuman
- Department of Pharmacy, Fred Hutch Cancer Center, Seattle, WA, USA
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Strobbe G, Gaboriau L, Abelé M, Villain A, Aelbrecht-Meurisse C, Carnot A, Le Deley MC, Léguillette C, Feutry F, Sakji I, Marliot G. Impact of histamine-2 antagonist shortage on the incidence of hypersensitivity reactions to paclitaxel: a reconsideration of premedication protocols in France (PACLIREACT Study). Eur J Clin Pharmacol 2023; 79:1229-1238. [PMID: 37438439 DOI: 10.1007/s00228-023-03536-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 06/29/2023] [Indexed: 07/14/2023]
Abstract
PURPOSE An international shortage of ranitidine led to adjustments in premedication regimens for paclitaxel-based chemotherapy in early October 2019. In this study, we implemented and evaluated an anti-allergic protocol without histamine-2 antagonists (H2As) and aimed to assess the risk of hypersensitivity reactions (HSRs) to the different premedication regimens used. METHODS We conducted a single-center observational retrospective study of paclitaxel administrations (7173 administrations in 831 patients). Between January 2019 and December 2020, all allergies reported were recorded. A mixed logistic regression model was implemented to predict the risk of allergy at each injection and to account for repeated administration per patient. RESULTS A total of 27 HSRs occurred in 24 patients. No protective effect was observed for H2A when comparing paclitaxel injections with H2A premedication versus without H2A (OR = 1.12, p = 0.84). There was also no significant difference in risk of HSR for famotidine versus ranitidine (OR = 0.79, p = 0.78). However, the risk of HSRs was significantly lower for paclitaxel injections with corticosteroids than for those without (OR = 0.08, p = 0.03). In addition, the risk of HSR was significantly higher for the first, second, or third paclitaxel injections than for the subsequent injections (OR = 10.1, p < 0.001). CONCLUSION We did not find substantial evidence of an increased risk of HSR due to the absence of H2A in the premedication protocols for paclitaxel. Thus, in contrary to the existing literature on paclitaxel, our findings support the use of a premedication protocol without H2A.
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Affiliation(s)
- Geoffrey Strobbe
- Pole produits de santé, Service de pharmacie, Centre Oscar Lambret, 3, rue Frédéric Combemale, 59020, Cedex BP307, Lille, France.
| | - Louise Gaboriau
- Centre Régional de Pharmacovigilance, Service de pharmacologie, CHU, Lille, France
| | - Marie Abelé
- Pole produits de santé, Service de pharmacie, Centre Oscar Lambret, 3, rue Frédéric Combemale, 59020, Cedex BP307, Lille, France
| | - Alexandre Villain
- Pole produits de santé, Service de pharmacie, Centre Oscar Lambret, 3, rue Frédéric Combemale, 59020, Cedex BP307, Lille, France
| | | | - Aurélien Carnot
- Pole d'oncologie médicale, Centre Oscar Lambret, Lille, France
| | | | | | - Frédéric Feutry
- Pole produits de santé, Service de pharmacie, Centre Oscar Lambret, 3, rue Frédéric Combemale, 59020, Cedex BP307, Lille, France
| | - Ilyes Sakji
- Pole produits de santé, Service de pharmacie, Centre Oscar Lambret, 3, rue Frédéric Combemale, 59020, Cedex BP307, Lille, France
| | - Guillaume Marliot
- Pole produits de santé, Service de pharmacie, Centre Oscar Lambret, 3, rue Frédéric Combemale, 59020, Cedex BP307, Lille, France
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Bahabri A, Barty R, Li N, Liu Y, Kovalova T, Chan AKC. Do Children With an Allergic Transfusion Reaction Require Premedication For All Blood Products? J Pediatr Hematol Oncol 2023; 45:e578-e581. [PMID: 36716241 DOI: 10.1097/mph.0000000000002630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/24/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Children with a history of allergic transfusion reactions (ATRs) receive antihistamine premedication with or without hydrocortisone to prevent subsequent reactions. We aim to examine the frequency of developing ATRs to subsequent different blood product type transfusions. METHODS A retrospective chart review of children who received blood product transfusions (packed red blood cells, platelets, frozen plasma, intravenous immunoglobin, albumin, and cryoprecipitate) and developed ATRs. Cases were identified through Transfusion Transmitted Injuries Surveillance System- Ontario database with a complementary chart review. Demographics and subsequent transfusions records were described. RESULTS During this period, 35,925 blood products were transfused to 4153 patients. Thirty-eight ATRs were reported in 30 patients. All ATRs were minor except 1 anaphylaxis to albumin transfusion. Seven patients (23%) developed multiple ATRs, and all of them were of the same blood product type. A total of 60 subsequent different blood product types were transfused to the 7 patients who had multiple ATRs; none of those transfusions caused ATR. CONCLUSION In children with a history of ATR, developing a reaction to a different blood product type is rare. Hence, premedicating those transfusions is not warranted.
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Affiliation(s)
- Aban Bahabri
- Department of Pediatrics, McMaster University, McMaster Children's Hospital
- Department of Pediatrics, King Saud University, College of Medicine, Riyadh, Saudi Arabia
| | - Rebecca Barty
- Department of Medicine, McMaster Centre for Transfusion Research, McMaster University
| | - Na Li
- Department of Medicine, McMaster Centre for Transfusion Research, McMaster University
- Department of Computing and Software, McMaster University
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Yang Liu
- Department of Medicine, McMaster Centre for Transfusion Research, McMaster University
| | - Tanya Kovalova
- Department of Medicine, Population Health Research Institute, ON
| | - Anthony K C Chan
- Department of Pediatrics, McMaster University, McMaster Children's Hospital
- Department of Medicine, McMaster Centre for Transfusion Research, McMaster University
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Nath S, Saha A, Srivastava A. Evaluating the Effect of Duloxetine Premedication on Postoperative Analgesic Requirement in Patients Undergoing Laparoscopic Cholecystectomies: A Prospective, Randomized, Double-Blinded, Placebo-Controlled Study. Clin J Pain 2022; 38:528-535. [PMID: 35696698 DOI: 10.1097/ajp.0000000000001052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 05/31/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim was to evaluate the effect of oral administration of preoperative duloxetine on postoperative pain and total analgesic requirement in the postoperative period as the primary objective. The secondary objective was to evaluate the perioperative hemodynamic parameters, sedation scores, demographic data, and incidence of side effects (if any) in patients undergoing laparoscopic cholecystectomy. MATERIALS AND METHODS This was a prospective, randomized, double-blind, placebo-controlled study conducted in a tertiary level medical college on 60 patients of either sex posted for laparoscopic cholecystectomies with American Society of Anesthesiologists (ASA) I and II. The patients were divided into 2 groups (n=30), the patients were given duloxetine 60 mg capsules and placebo capsules (Becosules) 2 hours before surgery. RESULTS The total requirement for both first and second rescue analgesics was higher in placebo as compared with duloxetine and was found to be significant ( P <0.05). The difference in mean visual analog scale score was significantly ( P <0.001) higher in placebo as compared with duloxetine at all-time intervals postoperatively 0 minute (7.6±0.7 vs. 4.6±0.8); 15 minutes (5.9±0.8 vs. 4.2±1.0); 30 minutes (4.4±0.5 vs. 3.6±0.9); 4 hours (6.6±0.06 vs. 5.3±1.3); 8 hours (5.2±1.2 vs. 3.9±1.0); and 12 hours (5.1±1.3 vs. 2.3±0.7). The mean arterial blood pressure and heart rate were significantly higher in placebo compared with duloxetine in most of the time intervals in the perioperative period. There was no significant difference in the sedation score between the groups except the 30 minutes and 8 hours postoperative. DISCUSSION Preoperative oral duloxetine during laparoscopic cholecystectomy could reduce postoperative pain, postoperative analgesic requirements, and better optimization of hemodynamics without causing major side effects.
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Affiliation(s)
- Shivika Nath
- Department of Anesthesiology, School of Medical Sciences and Research, Sharda University, Greater Noida, Uttar Pradesh, India
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Chi TT, Hay Kraus BL. The effect of intravenous maropitant on blood pressure in healthy awake and anesthetized dogs. PLoS One 2020; 15:e0229736. [PMID: 32108177 PMCID: PMC7046230 DOI: 10.1371/journal.pone.0229736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 02/13/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To evaluate the effects of intravenous maropitant on arterial blood pressure in healthy dogs while awake and under general anesthesia. DESIGN Experimental crossover study. ANIMALS Eight healthy adult Beagle dogs. PROCEDURE All dogs received maropitant (1 mg kg-1) intravenously under the following conditions: 1) awake with non-invasive blood pressure monitoring (AwNIBP), 2) awake with invasive blood pressure monitoring (AwIBP), 3) premedication with acepromazine (0.005 mg kg-1) and butorphanol (0.2 mg kg-1) intramuscularly followed by propofol induction and isoflurane anesthesia (GaAB), and 4) premedication with dexmedetomidine (0.005 mg kg-1) and butorphanol (0.2 mg kg-1) intramuscularly followed by propofol induction and isoflurane anesthesia (GaDB). Heart rate (HR), systolic (SAP), diastolic (DAP), and mean blood pressures (MAP) were recorded before injection of maropitant (baseline), during the first 60 seconds of injection, during the second 60 seconds of injection, at the completion of injection and every 2 minutes post injection for 18 minutes. The data were compared over time using a Generalized Linear Model with mixed effects and then with simple effect comparison with Bonferroni adjustments (p <0.05). RESULTS There were significant decreases from baseline in SAP in the GaAB group (p < 0.01) and in MAP and DAP in the AwIBP and GaAB (p < 0.001) groups during injection. A significant decrease in SAP (p < 0.05), DAP (p < 0.05), and MAP (p < 0.05) occurred at 16 minutes post injection in GaDB group. There was also a significant increase in HR in the AwIBP group (p < 0.01) during injection. Clinically significant hypotension occurred in the GaAB group with a mean MAP at 54 ± 6 mmHg during injection. CONCLUSION Intravenous maropitant administration significantly decreases arterial blood pressure during inhalant anesthesia. Patients premedicated with acepromazine prior to isoflurane anesthesia may develop clinically significant hypotension.
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Affiliation(s)
- Ting-Ting Chi
- Department of Veterinary Clinical Sciences, Iowa State University College of Veterinary Medicine, Ames, Iowa, United States of America
| | - Bonnie L. Hay Kraus
- Department of Veterinary Clinical Sciences, Iowa State University College of Veterinary Medicine, Ames, Iowa, United States of America
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Dasa O, Shafiq Q, Ruzieh M, Alhazmi L, Al-Dabbas M, Ammari Z, Khouri S, Moukarbel G. Patient Factors But Not the Use of Novel Anticoagulants or Warfarin Are Associated With Internal Jugular Vein Access-Site Hematoma After Right Heart Catheterization. J Invasive Cardiol 2017; 29:401-403. [PMID: 29207361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Right heart catheterization (RHC) is routinely performed to assess hemodynamics. Generally, anticoagulants are held prior to the procedure. At our center, anticoagulants are continued and ultrasound guidance is always used for internal jugular vein access. A micropuncture access kit is used to place a 5 or 6 Fr sheath using the modified Seldinger technique. Manual compression is applied for 10-15 min and the patient is observed for at least 2 hours after the procedure. In a retrospective analysis, we investigated the risk of bleeding complications associated with RHC via the internal jugular vein in patients with and without full anticoagulation. METHODS AND RESULTS Our catheterization laboratory database was searched for adult patients who underwent RHC by a single operator between January 2012 and December 2015. A total of 571 patients were included in the analysis. Baseline characteristics, labs, relevant invasive hemodynamics, co-morbid conditions, and incidence of access-site hematoma are presented. Multivariable binary logistic regression was performed using IBM SPSS v. 23.0 software. Statistically significant associations with access-site hematoma were observed with body mass index (P=.02; 95% confidence interval [CI], 1.0-1.1), right atrial pressure (P=.03; 95% CI, 0.7-0.9), and dialysis dependence (P<.01; 95% CI, 0.1-0.6). There was no association of access-site hematoma with the use of anticoagulants (P>.99). CONCLUSION The incidence of internal jugular vein access-site hematoma is small when using careful access techniques for RHC even with the continued use of novel oral anticoagulants and warfarin. Patient characteristics and co-morbid conditions are related to bleeding complications.
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Affiliation(s)
| | | | | | | | | | | | | | - George Moukarbel
- Division of Cardiovascular Medicine, The University of Toledo Medical Center, 3000 Arlington Avenue, Toledo, OH 43614 USA.
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Keles S, Kocaturk O. The Effect of Oral Dexmedetomidine Premedication on Preoperative Cooperation and Emergence Delirium in Children Undergoing Dental Procedures. Biomed Res Int 2017; 2017:6742183. [PMID: 28904966 PMCID: PMC5585600 DOI: 10.1155/2017/6742183] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 07/04/2017] [Accepted: 07/19/2017] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The aim of this study was to detect the effect of 1 μg/kg of oral dexmedetomidine (DEX) as premedication among children undergoing dental procedures. MATERIALS AND METHODS The study involved 100 children between 2 and 6 years of age, ASA I, who underwent full-mouth dental rehabilitation. The DEX group (n = 50) received 1 μg/kg DEX in apple juice, and the control group (n = 50) received only apple juice. The patients' scores on the Ramsay Sedation Scale (RSS), parental separation anxiety scale, mask acceptance scale, and pediatric anesthesia emergence delirium scale (PAEDS) and hemodynamic parameters were recorded. The data were analyzed using chi-square test, Fisher's exact test, Student's t-test, and analysis of variance in SPSS. RESULTS RSS scores were significantly higher in the DEX group than group C at 15, 30, and 45 min (p < 0.05). More children (68% easy separation, 74% satisfactory mask acceptance) in the DEX group showed satisfactory ease of parental separation and mask acceptance behavior (p < 0.05). There was no significant difference in the PAEDS scores and mean hemodynamic parameters of both groups. CONCLUSIONS Oral DEX administered at 1 μg/kg provided satisfactory sedation levels, ease of parental separation, and mask acceptance in children but was not effective in preventing emergence delirium. The trial was registered (Protocol Registration Receipt NCT03174678) at clinicaltrials.gov.
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Affiliation(s)
- Sultan Keles
- Department of Pediatric Dentistry, Faculty of Dentistry, Adnan Menderes University, Aydın, Turkey
| | - Ozlem Kocaturk
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Adnan Menderes University, Aydın, Turkey
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Karaman S, Gunusen I, Uyar M, Firat V. The Effect of Pre-operative Lornoxicam and Ketoprofen Application on the Morphine Consumption of Post-operative Patient-controlled Analgesia. J Int Med Res 2016; 34:168-75. [PMID: 16749412 DOI: 10.1177/147323000603400206] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We compared the efficacy of preoperative intramuscular lornoxicam and ketoprofen for post-operative analgesia in patients undergoing abdominal hysterectomy. This randomized, double-blind, placebo-controlled, parallel-group study investigated 60 patients who received lornoxicam (group L, 8 mg), ketoprofen (group K, 100 mg) or saline (group C) 60 min before standard anaesthesia. All patients received patient-controlled analgesia (intravenous morphine) during the post-operative period. Visual analogue scale (VAS) scores recorded 2, 4, 6 and 12 h after surgery in groups L and K patients were significantly lower than in group C patients, and VAS scores at 2, 4 and 6 h in group L patients were significantly lower than those in group K patients. Morphine consumption in groups L and K was significantly lower than in group C. Pre-emptive administration of lornoxicam and ketoprofen effectively reduced post-operative pain and morphine consumption, and lornoxicam was more effective than ketoprofen in the early post-operative period.
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Affiliation(s)
- S Karaman
- Department of Anaesthesiology and Reanimation, Ege University Faculty of Medicine, Ege University, Izmir, Turkey.
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Kim KW, Choe WJ, Kim JH, Kim KT, Lee SI, Park JS, Kim JW, Heo MH. Anticholinergic premedication-induced fever in paediatric ambulatory ketamine anaesthesia. J Int Med Res 2016; 44:817-23. [PMID: 27225859 PMCID: PMC5536636 DOI: 10.1177/0300060515595649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 06/16/2015] [Indexed: 11/15/2022] Open
Abstract
Objective A randomized, double-blind, prospective study to evaluate the effect of anticholinergic drugs on thermoregulation in paediatric patients undergoing ambulatory anaesthesia with ketamine. Methods Patients were randomized to receive either 0.005 mg/kg glycopyrrolate or the equivalent volume of normal saline (placebo) at 30 min before ketamine anaesthesia. Body temperature was measured tympanically at baseline and at 0, 30, 60 and 90 min postoperatively. The quantity of saliva prodiced during surgery and incidence of fever were recorded. Results Body temperature was significantly higher in the glycopyrrolate group (n = 42) than the placebo group (n = 42) at 30, 60 and 90 min after surgery, and higher than baseline at 0, 30, 60 and 90 min after surgery. In the placebo group, body temperature was significantly higher than baseline at 0 and 30 min after surgery. Saliva secretion was significantly lower in the glycopyrrolate group than the placebo group. Conclusion Routine premedication with adjunctive anticholinergics should not be considered in paediatric patients receiving ketamine sedation due to the increased risk of fever. Trial registration number, Clinicaltrials.gov: NCT02430272
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Affiliation(s)
- Kyung Woo Kim
- Department of Anaesthesia and Pain Medicine, Inje University Seoul Paik Hospital, Seoul, Republic of Korea
| | - Won Joo Choe
- Department of Anaesthesia and Pain Medicine, Inje University Ilsan Paik Hospital, Gyeonggi-do, Republic of Korea
| | - Jun Hyun Kim
- Department of Anaesthesia and Pain Medicine, Inje University Ilsan Paik Hospital, Gyeonggi-do, Republic of Korea
| | - Kyung-Tae Kim
- Department of Anaesthesia and Pain Medicine, Inje University Ilsan Paik Hospital, Gyeonggi-do, Republic of Korea
| | - Sang-Il Lee
- Department of Anaesthesia and Pain Medicine, Inje University Ilsan Paik Hospital, Gyeonggi-do, Republic of Korea
| | - Jang Su Park
- Department of Anaesthesia and Pain Medicine, Inje University Ilsan Paik Hospital, Gyeonggi-do, Republic of Korea
| | - Jung Won Kim
- Department of Anaesthesia and Pain Medicine, Inje University Ilsan Paik Hospital, Gyeonggi-do, Republic of Korea
| | - Min Hee Heo
- Department of Anaesthesia and Pain Medicine, Inje University Ilsan Paik Hospital, Gyeonggi-do, Republic of Korea
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Martinez-Moreno R, Aguilar M, Wendl C, Bäzner H, Ganslandt O, Henkes H. Fatal Thrombosis of a Flow Diverter due to Ibuprofen-related Antagonization of Acetylsalicylic Acid. Clin Neuroradiol 2015; 26:355-8. [PMID: 26631399 PMCID: PMC5025486 DOI: 10.1007/s00062-015-0487-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 11/17/2015] [Indexed: 11/27/2022]
Affiliation(s)
- R. Martinez-Moreno
- Neuroradiological Clinic, Katharinenhospital, Klinikum Stuttgart, Kriegsbergstraße 60, 70174 Stuttgart, Germany
| | - M. Aguilar
- Neuroradiological Clinic, Katharinenhospital, Klinikum Stuttgart, Kriegsbergstraße 60, 70174 Stuttgart, Germany
| | - C. Wendl
- Neuroradiological Clinic, Katharinenhospital, Klinikum Stuttgart, Kriegsbergstraße 60, 70174 Stuttgart, Germany
| | - H. Bäzner
- Neurological Clinic, Klinikum Stuttgart, Stuttgart, Germany
| | - O. Ganslandt
- Neurosurgical Clinic, Klinikum Stuttgart, Stuttgart, Germany
| | - H. Henkes
- Neuroradiological Clinic, Katharinenhospital, Klinikum Stuttgart, Kriegsbergstraße 60, 70174 Stuttgart, Germany
- Medical Faculty, University of Duisburg-Essen, Essen, Germany
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Abstract
A 63-year-old woman presented with intestinal disorder, alternating between obstipation and diarrhoea. Sodium phosphate/diphosphate (Fleet®) was used in preparation for colonoscopy. Within 24 h the patient developed severe hyperphosphatemia and oliguric acute kidney failure with the need of renal replacement therapy. This case illustrates the rare event of phosphate nephropathy after colonoscopy.
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Grossman D, Constant D, Lince-Deroche N, Harries J, Kluge J. A randomized trial of misoprostol versus laminaria before dilation and evacuation in South Africa. Contraception 2014; 90:234-41. [PMID: 24929888 DOI: 10.1016/j.contraception.2014.05.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 05/01/2014] [Accepted: 05/04/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare complication rates, efficacy and acceptability of buccal misoprostol to laminaria for cervical preparation before dilation and evacuation (D&E) in South Africa. STUDY DESIGN We performed a randomized, single-blind trial comparing buccal misoprostol 400 mcg (1-2 doses, administered at least 3 h before D&E) to laminaria inserted the day before D&E among women at 13-19 weeks gestation. The primary outcome was expulsion of the fetus prior to surgery; secondary outcomes included other complications, need for mechanical dilation, procedure duration, side effects and satisfaction. Required sample size was 176 to detect a difference in expulsion of 20% to 5%, with a two-sided alpha of 0.05 and 80% power. RESULTS Due to slow enrollment and low incidence of primary outcome, the study was stopped early. One hundred fifty-nine women were randomized, and 156 received treatment (78 in each group). Mean gestational age was 14.8 weeks (range, 13.0-18.6 weeks). Complications were rare and did not differ by group [three in each group; odds ratio (OR), 1; 95% confidence interval (CI), 0.20-5.11]; this included two expulsions in the misoprostol group (2.6%). Misoprostol participants were more likely to require mechanical dilation compared to those receiving laminaria (35% vs. 8%; OR, 6.4; 95% CI, 2.4-16.5). The proportion of women reporting each side effect was similar except for diarrhea (21.3% in misoprostol group vs. 5.2% in laminaria group, p=0.004). Procedure time and satisfaction did not differ between groups. CONCLUSIONS Both misoprostol and laminaria are associated with a low complication rate in this setting, although misoprostol requires more mechanical dilation and causes more diarrhea. IMPLICATIONS Cervical preparation using either laminaria or misoprostol can be safely used before D&E up to at least 19 weeks. Physicians using misoprostol must be skilled at mechanical dilation, since this is commonly required.
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Affiliation(s)
- Daniel Grossman
- Ibis Reproductive Health, Oakland, CA; Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA.
| | - Deborah Constant
- Women's Health Research Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Naomi Lince-Deroche
- Ibis Reproductive Health, Johannesburg, South Africa (at the time of the study); Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jane Harries
- Women's Health Research Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Judy Kluge
- Department of Obstetrics & Gynaecology, University of Stellenbosch and Tygerberg Hospital, Cape Town, South Africa
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Durán Bruce M, Gomar Sancho C, Holguera JC, Muliterno Español E. [Factors involved in the development of vasoplegia after cardiac surgery with extracorporeal circulation. A prospective observational study]. Rev Esp Anestesiol Reanim 2014; 61:246-253. [PMID: 24507583 DOI: 10.1016/j.redar.2013.11.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 11/19/2013] [Accepted: 11/28/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVE The incidence and risk factors for vasoplegia in the early postoperative period and at 24h are investigated in patients subjected to cardiopulmonary bypass surgery. Vasoplegia following cardiac surgery with cardiopulmonary bypass is associated with a high morbimortality. The risk factors described emerged from retrospective, non-controlled studies. METHODS Observational prospective study of 188 consecutive patients subjected to cardiac surgery with cardiopulmonary bypass in a single hospital between November 2011 and May 2012. Emergency surgery or complex procedures were excluded. Vasoplegia was assessed during the immediate postoperative period, and at 24h after surgery, and was defined as a mean arterial pressure below 50mmHg, and the need for a noradrenaline perfusion of more than 0.08μg/kg/min, monitored by cardiac output and systemic vascular resistances. The anaesthetic and cardiopulmonary bypass protocols, as well as haemodynamic management, were the same in all patients. RESULTS Almost half (48%) of patients had vasoplegia in the immediate postoperative period, and 34% at 24h. Risk factors for immediate vasoplegia development were preoperative use of angiotensin converting enzyme inhibitor drugs, a mean arterial pressure<50mmHg immediately after beginning cardiopulmonary bypass, duration of aortic clamping as well as the cardiopulmonary bypass, and minimum temperature in cardiopulmonary bypass. Vasoplegia at 24h after surgery was correlated to preoperative angiotensin converting enzyme inhibitor drug treatment and cardiopulmonary bypass duration. CONCLUSION The incidence of vasoplegia after cardiac surgery with cardiopulmonary bypass is high during the first 24 postoperative hours. Preoperative treatment with angiotensin converting enzyme inhibitor and the mean arterial pressure at the beginning of cardiopulmonary bypass are the more easily controllable risk factors. In patients arriving to surgery with those drugs, treatment or prevention of vasoplejia should be planned.
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Affiliation(s)
- M Durán Bruce
- Servicio de Anestesiología, Hospital San Borja Arriarán, Santiago de Chile, Chile.
| | - C Gomar Sancho
- Servicio de Anestesiología, Hospital Clínic, Barcelona, España
| | - J C Holguera
- Servicio de Anestesiología, Clínica Teknon, Barcelona, España
| | - E Muliterno Español
- Servicio de Anestesiología, Hospital Universitario Josep Trueta, Girona, España
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Montoya JE, Luna HG, Vergara NG, Amparo JR, Cristal-Luna GR. Incidence of infusion-related reaction to monoclonal antibody rituximab: a national kidney and transplant institute experience. Ann Acad Med Singap 2012; 41:125-126. [PMID: 22538739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Nakao T, Yoshida N, Nakane T, Terada Y, Nakamae H, Koh KR, Yamane T, Hino M. [Chronic myelogenous leukemia complicated by drug-induced agranulocytosis]. Rinsho Ketsueki 2011; 52:278-281. [PMID: 21646773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
We describe a patient with chronic myelogenous leukemia (CML) who developed drug-induced agranulocytosis. A 75-year-old female was diagnosed with CML in December 2001. She had been receiving imatinib therapy for more than five years. In August 2007, she was hospitalized due to a severe neutropenia 10 days after colonoscopy. She was diagnosed as having agranulocytosis induced by colonoscopy premedication including scopolamine butylbromide and flumazenil. Severe neutropenia was resolved by G-CSF treatment without CML progression. Agranulocytosis in patients with CML is rare, but potentially lethal. Here, we report the clinical course in this patient.
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Affiliation(s)
- Takafumi Nakao
- Department of Hematology, Osaka City University Hospital, Osaka, Japan
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Venkatesh V, Ponnusamy V, Anandaraj J, Chaudhary R, Malviya M, Clarke P, Arasu A, Curley A. Endotracheal intubation in a neonatal population remains associated with a high risk of adverse events. Eur J Pediatr 2011; 170:223-7. [PMID: 20842378 DOI: 10.1007/s00431-010-1290-8] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Accepted: 08/31/2010] [Indexed: 12/19/2022]
Abstract
INTRODUCTION There has been a significant increase in premedication use for neonatal intubation in the UK over the past decade. We aimed to determine the adverse events during neonatal intubation using the most commonly used premedication regimen in the UK. DISCUSSION We prospectively studied all intubations performed using morphine, suxamethonium and atropine during a 3-month period in three UK tertiary neonatal units. Premedication was administered for 87/93 (94%) of intubations. Median time taken to prepare premedication was 16 min (IQR 10-35). Median time to successful intubation was 5 min (IQR 2-9) following premedication. Median lowest recorded oxygen saturation after administration of premedication was 65% (IQR 39-85). A bradycardia in the range 61-99/min accompanied the procedure in 24/93 (26%) intubations, with a median duration of bradycardia of 8 s (IQR 1-10). CONCLUSION Despite the widespread move to premedication for neonatal intubation, many deficiencies in everyday practice remain. The rate of haemodynamic complications is high in this commonly used premedication regimen. This study shows that there are important factors to control at the local level in terms of timely preparation and administration of premedication drugs, training and supervision of staff carrying out this high-risk procedure.
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Shirahata A, Matsumiya A, Saito M, Ishibashi K, Kigawa G, Nemoto H, Sanada Y, Hibi K, Kou Y, Watanabe R. [A case of advanced breast cancer with anaphylaxis-like reaction after intravenous administration of dexamethasone]. Gan To Kagaku Ryoho 2009; 36:1383-1385. [PMID: 19692785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The patient was a 74-year-old woman who was diagnosed with advanced breast cancer, T4aN0M0, stage IV. She was placed on chemotherapy of weekly paclitaxel (PTX) (60 mg/m(2) day 1, 8, 15 with 1 course consisting of 28 days). We used dexamethasone (8 mg/body) as premedication for chemotherapy every time. Three courses were performed with no severe adverse reaction. On the fourth course, day 8, she complained of nausea, vomiting, paroxysmal cough and fecal incontinence after a few minutes of dexamethasone administration. Her blood pressure dropped to a minimum of 64 mmHg (systolic pressure) and she soon became drowsy. We diagnosed the anaphylaxis-like reaction for dexamethasone, immediately discontinued dexamethasone infusion, and treated her successfully. Forty minutes after the episode had occurred, she recovered. The few reports on anaphylaxis or anaphylaxis-like reaction to dexamethasone must be taken into account when we use these drugs.
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Bozdogan N, Yildirim SV. Intranasal clonidine as a premedicant: three cases with unique indications. Paediatr Anaesth 2008; 18:800. [PMID: 18613939 DOI: 10.1111/j.1460-9592.2008.02549.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ogonowska-Kobusiewicz M, Rutyna R, Nestorowicz A. [Perioperative risk in patients with sleep apnoea]. Anestezjol Intens Ter 2008; 40:182-187. [PMID: 19469121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Patients with upper airway obstruction during sleep are at constant risk of hypoxic and hypercarbic episodes and are especially vulnerable during anaesthesia and sedation as the abnormal anatomy is compounded by drug-related respiratory depression. Elective procedures in patients with the obstructive sleep apnoea (OSA) should be usually delayed, allowing for the preoperative home treatment (diet, alcohol abstinence, nasal CPAP/BiPAP during night). Respiratory supportive techniques, started at home, should be continued in the hospital, both in preoperative and postoperative periods. Patients with OSA should be also thoroughly examined for possible anatomic abnormalities of the upper airway that may complicate laryngoscopy and/or intubation. Heavy premedication should be avoided; in special cases of very nervous patients oral clonidine may be used. Careful preoxygenation is mandatory, opioids should be used sparingly. Muscle relaxant should be calculated for an ideal body weight. Isoflurane should be avoided. The OPS and obese patients are usually extubated in the sitting or lateral positions to avoid limitation of FRC by elevated diaphragm. In selected cases, prolonged intubation and/or ventilation are recommended. Regional anaesthesia are usually safe in these patients, however, opioids should be used carefully. When sedation is required, ketamine or dexmedetomidine may be used.
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Bilchik AJ, Hecht JR. Perioperative risks of bevacizumab and other biologic agents for hepatectomy: theoretical or evidence based? J Clin Oncol 2008; 26:1786-8. [PMID: 18398144 DOI: 10.1200/jco.2007.15.6380] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Nagler J, Hammarth PM, Poppers DM. Seizures in an Alzheimer's disease patient as a complication of colonoscopy premedication with meperidine. Dig Dis Sci 2008; 53:62-4. [PMID: 17492380 DOI: 10.1007/s10620-007-9822-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2006] [Accepted: 03/07/2007] [Indexed: 12/09/2022]
Abstract
We describe the first reported case of generalized tonic-clonic seizures induced by meperidine premedication for a colonoscopy procedure in a 63-year-old woman with Alzheimer's disease. The active metabolite of meperidine, normeperidine, is postulated to be the precipitating cause of the seizures, although a cholinesterase inhibitor and an N-methyl-D: -aspartate receptor antagonist, both routinely used for treatment of Alzheimer's disease, may have contributed by reducing the seizure threshold. The neuronal changes which occur in Alzheimer's disease can themselves also predispose to seizures. We recommend avoidance of meperidine for all flexible endoscopic procedures on patients with Alzheimer's disease and in any patient with a condition that predisposes to seizures, and suggest the use of alternative opioids.
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Affiliation(s)
- Jerry Nagler
- Weill Medical College of Cornell University, New York, NY 10021, USA.
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Wrench I. Oral clonidine vs midazolam in the prevention of sevoflurane-induced agitation in children. Br J Anaesth 2007; 99:445; author reply 445. [PMID: 17702830 DOI: 10.1093/bja/aem222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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D'Angelo Vanni SM, Castiglia YMM, Ganem EM, Rodrigues Júnior GR, Amorim RB, Ferrari F, Braz LG, Braz JRC. Preoperative warming combined with intraoperative skin-surface warming does not avoid hypothermia caused by spinal anesthesia in patients with midazolam premedication. SAO PAULO MED J 2007; 125:144-9. [PMID: 17923938 PMCID: PMC11020579 DOI: 10.1590/s1516-31802007000300004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2005] [Revised: 12/01/2005] [Accepted: 05/24/2007] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE Inadvertent perioperative hypothermia is common during spinal anesthesia and after midazolam administration. The aim of this study was to evaluate the effects of intraoperative skin-surface warming with and without 45 minutes of preoperative warming in preventing intraoperative and postoperative hypothermia caused by spinal anesthesia in patients with midazolam premedication. DESIGN AND SETTING Prospective and randomized study at Hospital das Clínicas, Universidade Estadual Paulista, Botucatu. METHODS Thirty patients presenting American Society of Anesthesiologists (ASA) physical status I and II who were scheduled for elective lower abdominal surgery were utilized. The patients received midazolam premedication (7.5 mg by intramuscular injection) and standard spinal anesthesia. Ten patients (Gcontrol) received preoperative and intraoperative passive thermal insulation. Ten patients (Gpre+intra) underwent preoperative and intraoperative active warming. Ten patients (Gintra) were only warmed intraoperatively. RESULTS After 45 min of preoperative warming, the patients in Gpre+intra had significantly higher core temperatures than did the patients in the unwarmed groups (Gcontrol and Gintra) before the anesthesia (p < 0.05) but not at the beginning of surgery (p > 0.05). The patients who were warmed intraoperatively had significantly higher core temperatures than did the patients in Gcontrol at the end of surgery (p < 0.05). All the patients were hypothermic at admission to the recovery room (T CORE < 36 degrees C). CONCLUSIONS Forty-five minutes of preoperative warming combined with intraoperative skin-surface warming does not avoid but minimizes hypothermia caused by spinal anesthesia in patients with midazolam premedication.
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Affiliation(s)
- Simone Maria D'Angelo Vanni
- Department of Anesthesiology, School of Medicine, Universidade Estadual Paulista, Botucatu, São Paulo, Brazil
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Veitenhansl M, Reisch N, Schmauss S, Wörnle M, Gärtner R. [Hyponatraemic encephalopathy and rhabdomyolysis. Complications after preparation for colonoscopy with mannitol]. Internist (Berl) 2007; 48:625-9. [PMID: 17333050 DOI: 10.1007/s00108-007-1815-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In the preparation for colonoscopy, it is necessary to drink a great deal of often hypo-osmotic fluid. Therefore, the electrolytes and intra- and extracellular water are disequilibrated. Most of the patients tolerate this without any subjective or objective symptoms. In our case, a young male patient suffered from a severe hyponatriaemia with encephalopathy for more than 48 h through the preparation for an elective ambulant colonoscopy with mannite. Furthermore, he developed a rhabdomyolysis (either through lying on the floor in coma for more than 9 h, through the hyponatriaemia itself or through compensation of the hyponatriaemia) that lasted for ca. 1 week.
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Affiliation(s)
- M Veitenhansl
- Medizinische Klinik, Klinikum der Universität München, Standort Innenstadt, Ziemssenstrasse 1, 80336 Munich, Germany.
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Dabrowska B. [Apical ballooning syndrome - terminology for translating]. Kardiol Pol 2007; 65:113. [PMID: 17444024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
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Grabowski M, Karpiński G, Kochman J, Kochanowski J, Piatkowski R, Scisło P, Filipiak KJ, Opolski G. [Apical ballooning syndrome in a 57-year-old woman during premedication for general anaesthesia]. Kardiol Pol 2006; 64:1110-2. [PMID: 17089243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Apical ballooning after sudden emotional stress is a new syndrome characterised by abrupt onset of angina-like chest pain, ST-segment elevation, wall motion abnormalities involving the lower anterior wall and apex without significant coronary artery stenosis. We present a case of a 57-year-old woman with apical ballooning syndrome which occurred during premedication the general anaesthesia. We also found an increased B-type natriuretic peptide level in this patent--the finding not reported previously in the literature.
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Affiliation(s)
- Marcin Grabowski
- I Katedra i Klinika Kardiologii AM, Samodzielny Publiczny Centralny Szpital Kliniczny, ul. Banacha 1a, 02-097 Warszawa.
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Abstract
BACKGROUND Emergence delirium in the post-anaesthesia care unit (PACU) is poorly understood. The goal of this prospective study was to determine frequency and risk factors of emergence delirium in adults after general anaesthesia. METHODS In this prospective study, 1,359 consecutive patients were included. Contextual risk factors and occurrence of delirium according to the Riker sedation scale were documented. Groups were defined for the analysis according to the occurrence or not of agitation, then after exclusion of patients with preoperative anxiety and neuroleptics, or both, and antidepressants or benzodiazepines treatments. RESULTS Sixty-four (4.7%) patients developed delirium in the PACU, which can go from thrashing to violent behaviour and removal of tubes and catheters. Preoperative anxiety was not found to be a risk factor. Preoperative medication by benzodiazepines (OR=1.910, 95% CI=1.101-3.315, P=0.021), breast surgery (OR=5.190, 95% CI=1.422-18.947, P=0.013), abdominal surgery (OR=3.206, 95% CI=1.262-8.143, P=0.014), and long duration of surgery increased the risk of delirium (OR=1.005, 95% CI=1.002-1.008, P=0.001), while a previous history of illness and long-term treatment by antidepressants decreased the risk (respectively, OR=0.544, 95% CI=0.315-0.939, P=0.029 and OR=0.245, 95% CI=0.084-0.710, P=0.010). CONCLUSIONS Preoperative benzodiazepines, breast and abdominal surgery and surgery of long duration are risk factors for emergence delirium.
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Affiliation(s)
- C Lepousé
- Department of Anaesthesiology and Intensive Care, Hôpital Robert Debré CHU Reims, REIMS Cedex, F-51092, France.
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Wölfer J, Bantel C, Köhling R, Speckmann EJ, Wassmann H, Greiner C. Electrophysiology in ischemic neocortical brain slices: species differences vs. influences of anaesthesia and preparation. Eur J Neurosci 2006; 23:1795-800. [PMID: 16623836 DOI: 10.1111/j.1460-9568.2006.04696.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Ischemia models are indispensable for the evaluation of measures to be clinically applied to brain trauma or stroke patients. Slice models provide good control over experimental parameters and allow for comparative examinations of human and animal brain tissue. Experimental tissue, however, may be altered by anaesthesia, preparatory technique, and, in the case of human tissue, by underlying diseases. These influences on tissue behaviour under ischemia were examined electrophysiologically. Native rat tissue slices were prepared either immediately after decapitation (n = 13), during short ether/barbiturate narcosis (n = 18), or after two hours of inhalation anaesthesia (n = 12) imitating clinical narcosis. Tissue from rats in which generalized amygdala-kindled seizures had been triggered by electric stimulation (n = 10) was prepared according to the decapitation protocol, while human tissue (n = 10) was obtained during epilepsy or tumour surgery. Electrophysiological data (latency and amplitude of anoxic depolarization, recovery of evoked potentials) were recorded during ischemia simulation. Neither details of preparation or anaesthesia nor a history of epileptic fits were associated with significant changes of electrophysiological reactions under ischemia. Human tissue showed a significantly higher ability to uphold transmembrane ion gradients under ischemia. The ability of brain tissue to withstand ischemia is obviously species dependent. For the transfer of experimental results into clinical use it is important that interspecies differences alone can bring about a significant change of tissue behaviour.
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Affiliation(s)
- Johannes Wölfer
- Klinik und Poliklinik für Neurochirurgie am Universitätsklinikum Münster, Albert-Schweitzer-Strasse 33, D-48149 Münster, Germany.
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Martín Rubio AM, Aguilar Franco C. [On the new guidelines for inhibitors of hemostasis and regional neuraxial anesthesia]. Rev Esp Anestesiol Reanim 2006; 53:199-200; author reply 200-1. [PMID: 16671267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
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Affiliation(s)
- M Levine
- Department of CE&B, McMaster University, Hamilton, ON, Canada.
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Affiliation(s)
- M V Huisman
- Department of General Internal Medicine, LUMC, Leiden, The Netherlands.
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Affiliation(s)
- G Agnelli
- Department of Internal Medicine, Division of Internal and Vascular Medicine, Stroke Unit, University of Perugia, Italy.
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Berntorp E, Abshire T. The von Willebrand Disease Prophylaxis Network (vWD PN): Exploring a treatment concept. Thromb Res 2006; 118 Suppl 1:S19-22. [PMID: 16545435 DOI: 10.1016/j.thromres.2006.01.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2006] [Revised: 01/16/2006] [Accepted: 01/24/2006] [Indexed: 11/20/2022]
Abstract
The von Willebrand Disease Prophylactic Network (vWD PN) has been initiated to study the natural history of vWD bleeding, and to prospectively study the role of von Willebrand Factor (vWF) concentrate prophylaxis in vWD. Patients with all types of vWD in need of treatment with vWF concentrate will be enrolled into the study. Quality of life will be measured and safety and efficacy will be monitored at pre-determined intervals. Between February 2005 and July 18, 2005, 62 investigators from Europe and North America participating in the vWD PN, and 61 have submitted census data. A total 5343 patients have been identified for enrollment, and of these, 991 patients were treated with plasma-derived products in the preceding 12 months, and 99 patients have received prophylaxis, predominantly for joint-related bleeds. The vWD PN aims to further elucidate the role of vWF concentrate prophylaxis in vWD and to identify patients most likely to benefit from prophylaxis.
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Affiliation(s)
- Erik Berntorp
- Department of Coagulation Disorders, Malmö University Hospital, Malmö, Sweden.
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Abstract
OBJECTIVE To compare the haemodynamic effect of low dose midazolam and etomidate as induction agent in emergency department rapid sequence intubation. METHODS A prospective observational study in two phases. In phase one, midazolam 2-4 mg was used as induction agent and in phase two, etomidate 0.2-0.3 mg/kg was used. The haemodynamic data were recorded before and after intubation for comparison. Changes in mean systolic blood pressure were analysed with SPSS software. RESULTS A 10% decrease in mean systolic blood pressure was observed in the midazolam group (p = 0.001) while there was no significant change in the etomidate group. Some 19.5% of patients had hypotension after being given midazolam while only 3.6% with etomidate (p = 0.002). Patients older than 70 tended to have more hypotension episodes but the difference was not statistically significant. CONCLUSIONS Midazolam, even in low dose, was more likely than etomidate to cause significant hypotension when used as an induction agent for rapid sequence intubation. Etomidate is a better alternative.
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Affiliation(s)
- Y F Choi
- Accident and Emergency Department, Pamela Youde Nethersole Eastern Hospital, 3, Lok Man Road, Hong Kong SAR.
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Kuczkowski KM. Anaphylaxis and anesthesia. Minerva Anestesiol 2005; 71:54-5. [PMID: 15711507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
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Abstract
A patient was referred to the intensive care unit with sudden delirium and a serum sodium level of 111 mEq/L (mmol/L). A computerized tomographic scan revealed marked cerebral edema. Laboratory values were highly consistent with the action of the antidiuretic hormone. She had received desmopressin acetate (DDAVP) for 4 days preoperatively and postoperatively for putative van Willebrand's disease. Hyponatremia as a sequel to DDAVP treatment is an unusual complication and the medication is generally safe. However, our patient nevertheless teaches that vigilance equals avoidance.
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Affiliation(s)
- Adrian Schreiber
- Medical Faculty of the Charité, Franz Volhard Clinic HELIOS Klinikum Berlin, Berlin, Germany
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Abstract
PURPOSE The implications of recent studies for guidelines that pertain to stress ulcer prophylaxis in the postoperative period are discussed. SUMMARY The therapeutic guidelines on stress ulcer prophylaxis published by the American Society of Health-System Pharmacists (ASHP) provided clinicians with recommendations regarding appropriate candidates for stress ulcer prophylaxis and selection of a pharmacologic agent. Since these guidelines were published in 1999, additional research has been completed to resolve some of the controversial issues surrounding stress ulcer prophylaxis. The frequency of stress-induced bleeding in recent investigations continues to be highly variable, depending on the definition used to describe bleeding. In general, investigations that evaluate overt bleeding or bleeding without hemodynamic changes or blood transfusion report higher frequencies of bleeding than those that evaluate clinically important bleeding. Similar to that reported in the initial ASHP guidelines, the frequency of clinically important bleeding in recent investigations is low. In addition, the majority of recently published prospective studies and a meta-analysis have been unable to demonstrate a reduction in clinically important bleeding with pharmacologic agents. As a result, some experts have suggested that advances in critical care are more influential in the development of stress-induced bleeding than the use of pharmacologic agents. Recently published investigations support the effectiveness of institution-specific guidelines to help clinicians identify appropriate candidates for stress ulcer prophylaxis. The selection of an optimal pharmacologic agent for stress ulcer prophylaxis continues to be debated. The majority of recent studies have involved the administration of proton-pump inhibitors (PPIs). In general, these studies have demonstrated that PPIs are at least as effective as histamine H2-receptor antagonists at increasing gastric pH, but adequately powered studies investigating the endpoint of clinically important bleeding are needed. Similar to the initial ASHP guidelines, the development of institution-specific guidelines is recommended to identify the most appropriate pharmacologic treatment. CONCLUSION The frequency of clinically important bleeding reported in recent studies is low. The majority of recently published prospective studies and meta-analyses found little significant reduction in bleeding with pharmacologic prophylaxis.
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Affiliation(s)
- Michelle E Allen
- Adult Critical Care, Shands at the University of Florida, Gainesville, USA
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Collet JP, Montalescot G, Golmard JL, Tanguy ML, Ankri A, Choussat R, Beygui F, Drobinski G, Vignolles N, Thomas D. Subcutaneous enoxaparin with early invasive strategy in patients with acute coronary syndromes. Am Heart J 2004; 147:655-61. [PMID: 15077081 DOI: 10.1016/j.ahj.2003.10.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Subcutaneous enoxaparin during at least 48 hours provides adequate anticoagulation and good clinical results in patients with non-ST-segment elevation acute coronary syndromes undergoing percutaneous coronary intervention (PCI). METHODS In this nonrandomized retrospective study, we compared 347 patients with non-ST-segment elevation acute coronary syndromes who underwent rapid PCI after only 2 injections of subcutaneous enoxaparin (EI, n = 117) to those referred later to the catheterization laboratory with >or=3 injections (DI, n = 230). We measured anti-Xa at the time of PCI and evaluated bleeding and major ischemic events (death/myocardial infarction) at 30 days. RESULTS Patients in the EI group more frequently received glycoprotein IIb/IIIa inhibitors and clopidogrel preceding PCI than did patients in the DI group (58.1% vs 31.7%, P <.0001 for glycoprotein IIb/IIIa inhibitors and 68.4% vs 40.4% for clopidogrel pretreatment, P <.0001, respectively). The anti-Xa activity measured at the time of catheterization (0.92 +/- 0.04 U/mL vs 0.96 +/- 0.02 U/mL, EI vs DI, P =.25) and the injection-to-catheterization times (5.6 +/- 0.2 h vs 5.2 +/- 0.1 h, EI vs DI, P =.17) were similar in both groups. The 30-day bleeding rates of 1.7% and 4.8% in the EI and DI strategies were found to be equivalent with a significant non-inferiority test for the EI strategy (P <.05). There was a nonsignificant trend for less death or myocardial infarction at 30 days in the EI group compared to the DI group (4.3% vs 7.0%, non-inferiority test not significant). CONCLUSION A rapid invasive strategy with only 2 subcutaneous injections of enoxaparin provides similar levels of anticoagulation, and is associated with a favorable trend for ischemic events and with safety equivalent to a more prolonged "upstream" treatment with enoxaparin.
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Affiliation(s)
- J P Collet
- Department of Cardiology, Pitié-Salpêtrière Hospital, Paris, France
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Ellis SG, Armstrong P, Betriu A, Brodie B, Herrmann H, Montalescot G, Neumann FJ, Smith JJ, Topol E. Facilitated percutaneous coronary intervention versus primary percutaneous coronary intervention: design and rationale of the Facilitated Intervention with Enhanced Reperfusion Speed to Stop Events (FINESSE) trial. Am Heart J 2004; 147:E16. [PMID: 15077099 DOI: 10.1016/j.ahj.2003.07.025] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) has emerged as the strategy of choice in reestablishing effective flow in occluded infarct-related arteries in patients with acute myocardial infarction (MI) if it can be administered in a timely fashion. Patients who enter the catheterization laboratory with Thrombolysis In Myocardial Infarction (TIMI) grade 3 blood flow in the infarct-related vessel have better clinical outcomes than patients presenting with impaired flow. We hypothesize that a strategy of early pharmacologic reperfusion therapy with abciximab alone or in conjunction with reduced-dose reteplase, followed by PCI will improve the outcome of patients eligible for primary PCI. STUDY DESIGN The Facilitated Intervention with Enhanced Reperfusion Speed to Stop Events (FINESSE) study is a 3000-patient, prospective, multicenter, randomized, double-blind, placebo-controlled trial. The study is designed to compare the efficacy and safety of early administration of reduced-dose reteplase and abciximab combination therapy or abciximab alone followed by PCI with abciximab alone administered just before PCI for acute MI. Patients will be randomized to one of these 2 facilitated PCI treatments or primary PCI in a 1:1:1 fashion. The primary efficacy end point of FINESSE is the composite of all-cause mortality or post-MI complications within 90 days of randomization. The primary safety outcome assessment will be Thrombolysis In Myocardial Infarction (TIMI) major bleeding. CONCLUSIONS The FINESSE study will answer important questions regarding the efficacy and safety of "upstream" medical therapy followed by planned intervention for patients with ST-elevation MI, potentially expanding the population eligible for a primary PCI approach. This study will also provide insight as to which facilitated regimen (reteplase/abciximab combination therapy or abciximab monotherapy) provides the best balance of efficacy and safety.
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Sinha PK, Ambesh SP. Pre-operative psychosis following oral lorazepam. Anaesthesia 2003; 58:1036. [PMID: 12969063 DOI: 10.1046/j.1365-2044.2003.03415_17.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Adverse drug reaction reports were compiled from the National Registry of Drug-Induced Ocular Side Effects, Casey Eye Institute, Portland, Oregon, USA; the United States Food and Drug Administration, Rockville, Maryland; the World Health Organization, Uppsala, Sweden; and a Medline literature review of the past 50 years. The reported side effects of mydriatics, cycloplegics, benzodiazepines, tetracyclines, iodine, topical anesthetics, medications used for hemostasis, nonsteroidal antiinflammatory drugs, steroids, antibiotics, and artificial tears are described. Physicians should be aware of the side-effect profile and current industry standards for medications used in corneal refractive surgery, including off-label uses. Guidelines are provided for some classes of medications.
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Caumo W, Hidalgo MPL, Schmidt AP, Iwamoto CW, Adamatti LC, Bergmann J, Ferreira MBC. Effect of pre-operative anxiolysis on postoperative pain response in patients undergoing total abdominal hysterectomy. Anaesthesia 2002; 57:740-6. [PMID: 12133084 DOI: 10.1046/j.1365-2044.2002.02690.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In a double blind, placebo-controlled trial, we have assessed the effects of pre-operative anxiolysis on postoperative pain scores in 112 ASA I-II women, aged 18-65 years, scheduled to undergo total abdominal hysterectomy. Subjects were randomly allocated to receive either oral diazepam 10 mg (n=56) or placebo (n=56) pre-operatively. Postoperative anxiety, pain scores, analgesic consumption, and sedation were evaluated at several time points during the first 24 h following surgery. Postoperative pain scores were found to be significantly higher in the diazepam group. Trait and state anxiety showed a significant effect on pain scores, independent of the treatment group. No difference was found between the groups in morphine consumption, but there was a significant reduction in morphine consumption with time.
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Affiliation(s)
- W Caumo
- Anaesthesia Service, Hospital de Clínicas de Port Alegre, Universidade Federal do Rio Grande do Sul, UFRGS, Brazil.
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