scholarly journals The propofol-sparing effect of intravenous lidocaine in elderly patients undergoing colonoscopy: a randomized, double-blinded, controlled study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Mengmeng Chen ◽  
Yi Lu ◽  
Haoran Liu ◽  
Qingxia Fu ◽  
Jun Li ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Normal Saline ◽  
Body Movement ◽  
Final Analysis ◽  
The Elderly ◽  
Controlled Study ◽  
Intravenous Lidocaine ◽  
Cardiopulmonary Complications ◽  
Sparing Effect ◽  
Double Blinded

Abstract Background Propofol provides a prominent sedation effect in colonoscopy. However, anesthesia and sedation induced with propofol in the elderly might result in cardiopulmonary complications, especially when it is combined with opoids in the regimen. This study aimed to test the hypothesis that the addition of intravenous lidocaine to propofol-based sedation could decrease the overall propofol requirement in elderly patients during colonoscopy while the procedural sedation satisfaction and the hemodynamic stability were not compromised. Methods Ninety-two patients undergoing colonoscopy were randomly enrolled into lidocaine+propofol (L + P) group or normal saline+propofol (NS + P) groups. Subjects received intravenous bolus of 1.5 mg/kg lidocaine followed by 4 mg kg− 1 h− 1 lidocaine continuous infusion in L + P group or equivalent volumes of normal saline for boluses and infusion in NS + P group. Anesthesia was induced with 2.5 μg sufentanil followed by injection of 1.2 mg kg− 1 propofol in all patients. A single supplemental bolus of 0.6 mg kg− 1 propofol was administered whenever MOAA/S score > 1 or had body movement during the colonoscopy. The recorded primary endpoints included: the total amount of propofol administered during entire procedure, the supplemental amount of propofol after induction, and the frequencies of boluses of supplemental propofol. Results A total of 79 patients were included in the final analysis. Compared with NS + P group, the total amounts of propofol (induction plus supplemental) were no significant differences in L + P group; however, the required supplemental propofol was less (69.9 ± 39.2 mg vs. 51.5 ± 38.6 mg) (P = 0.039); the average frequencies of boluses of supplemental propofol given after induction were lower (2.1 ± 1.1 vs. 1.4 ± 0.9) (P = 0.003); the calculated “unit propofol” infusion rate was lower (0.18 ± 0.05 vs. 0.14 ± 0.04 mg kg− 1 min− 1) (P = 0.002). Conclusions The addition of intravenous lidocaine to propofol-based sedation resulted in a remarked reduction of supplemental propofol in the elderly during colonoscopy. Trial registration The present clinical trial was registered at http://www.chictr.org.cn on 11th March 2019 (registration No. ChiCTR1900021818).

scholarly journals A Comparison of Three Fluid-Vasopressor Regimens Used to Prevent Hypotension during Subarachnoid Anaesthesia in the Elderly

1998 ◽  
Vol 26 (5) ◽  
pp. 497-502 ◽  
Author(s):  
J. C. M. Yap ◽  
L. A. H. Critchley ◽  
S. C. Yu ◽  
R. M. Calcroft ◽  
J. L. Derrick
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Arterial Pressure ◽  
Elderly Patients ◽  
Hip Fractures ◽  
Normal Saline ◽  
Computer Software ◽  
Systolic Arterial Pressure ◽  
The Elderly ◽  
Group A

We aimed to compare the efficacy of fluid preloading with two recently recommended fluid-vasopressor regimens for maintaining blood pressure during subarachnoid anaesthesia in the elderly. Sixty elderly patients requiring surgery for traumatic hip fractures received subarachnoid anaesthesia using 0.05 ml/kg of 0.5% heavy bupivacaine. Hypotension, i.e. systolic arterial pressure <75% of baseline, was prevented or treated by: A—normal saline 16 ml/kg plus intravenous ephedrine boluses (0.1 mg/kg); B—normal saline 8 ml/kg plus intramuscular depot ephedrine (0.5 mg/kg); or C—Haemaccel 8 ml/kg plus metaraminol infusion. Systolic arterial pressure and heart rate were recorded using custom-written computer software (Monitor, version 1.0). Systolic arterial pressure decreased in all groups after five minutes (P<0.001). Decreases were greatest in group A (P<0.05). Heart rate increased by 7% group A and decreased by 9% in group C (P<0.05). During the first hour, hypotension was present for 47%, 25% and 20% of the time in groups A, B and C respectively and overcorrection of systolic arterial pressure occurred in 19% of the time in group C. We conclude that treatment A was inadequate in preventing hypotension. Treatments B and C were more effective but were associated with an increased heart rate and overcorrection of systolic arterial pressure respectively.

scholarly journals Efficacy of Citalopram in the prevention of recurrent depression in elderly patients: Placebo-controlled study of maintenance therapy

2002 ◽  
Vol 181 (1) ◽  
pp. 29-35 ◽  
Author(s):  
René Klysner ◽  
Jesper Bent-Hansen ◽  
Hanne L. Hansen ◽  
Marianne Lunde ◽  
Elisabeth Pleidrup ◽  
...  
Keyword(s):  
Major Depression ◽  
Elderly Patients ◽  
Rating Scale ◽  
The Elderly ◽  
Term Treatment ◽  
Fixed Dose ◽  
Controlled Study ◽  
Recurrence Time ◽  
Long Term Treatment

BackgroundThe highly recurrent nature of major depression in the young and the elderly warrants long-term antidepressant treatment.AimsTo compare the prophylactic efficacy of citalopram and placebo in elderly patients; to evaluate long-term tolerability of citalopram.MethodOut-patients, ⩾65 years, with unipolar major depression (DSM – IV: 296.2 x or 296.3 x) and Montgomery – Åsberg Depression Rating Scale score ⩾22 were treated with citalopram 20–40 mg for 8 weeks. Responders continued on their final fixed dose of citalopram for 16 weeks before randomisation to double-blind treatment with citalopram or placebo for at least 48 weeks.ResultsNineteen of the 60 patients using citalopram v. 41 of the 61 patients using placebo had recurrence. Time to recurrence was significantly different between citalopram— and placebo-patients, in favour of citalopram (log-rank test, P < 0.0001). Long-term treatment was well tolerated.ConclusionsLong-term treatment with citalopram is effective in preventing recurrence of depression in the elderly and is well tolerated.

scholarly journals Application of intravenous lidocaine in patients undergoing operative hysteroscopy: a randomized, double-blind, controlled study

2019 ◽  
Author(s):  
Huaxin Wang ◽  
Xuan Peng ◽  
Yeda Xiao ◽  
Bo Zhao ◽  
Liying Zhan
Keyword(s):  
Controlled Study ◽  
Intravenous Lidocaine ◽  
Double Blind ◽  
Operative Hysteroscopy ◽  
Throat Pain ◽  
Equivalent Rate ◽  
Operative Recovery ◽  
Double Blinded ◽  
Blinded Trial

Abstract Background The role of intraoperative intravenous lidocaine infusion has been previously evaluated for pain relief, inflammatory response, and post-operative recovery, including in endoscopic surgery. The present study is a randomized double-blinded trial in which we evaluated whether intravenous lidocaine infusion would reduce postoperative pain, propofol requirement and remifentanil consumption in patients undergoing hysteroscopy surgery. Methods Eighty-five patients scheduled to undergo elective operative hysteroscopy surgery under general anesthesia were randomized into two groups. Group L included patients who received an intravenous lidocaine bolus 1.5mg/kg over 3 min followed by a continuous infusion at the rate of 2 mg/kg/h until surgery completed, and Group C received 0.9% normal saline solution at an equivalent rate. The depth of anesthesia was monitored using the Narcotrend, which was based on measurement of the patient’s cerebral electrical activity. Primary outcome of the study was postoperative hypogastric pain evaluating by visual analogue scale (VAS). Secondary outcomes include propofol requirement and remifentanil requirement. Results VAS score of Group L was significantly lower than Group C at postoperative 0.5 h, 4 h, respectively (P < 0.05), while no obvious difference was found at postoperative 24 h. There was no difference between groups in propofol requirement, but Group L required less dosage of remifentanil than Group C (P < 0.05). Moreover, the incidence of throat pain was significantly lower in Group L. No adverse events associated with lidocaine was discovered. Conclusions Administration of intravenous lidocaine infusion as an adjuvant alleviated short-term postoperative hypogastric pain and throat pain, and reduced remifentanil requirement in patients undergoing operative hysteroscopy surgery.

scholarly journals Comparison of Neuromuscular Blockade with Rocuronium in Young and Elderly Patients with or without Renal Failure

2016 ◽  
Vol 1 (2) ◽  
pp. 45-51
Author(s):  
L Pradeep
Keyword(s):  
Renal Failure ◽  
Statistical Analysis ◽  
Elderly Patients ◽  
General Anesthesia ◽  
Neuromuscular Blockade ◽  
Young Patients ◽  
Onset Time ◽  
The Elderly ◽  
Neuromuscular Monitoring ◽  
Controlled Study

ABSTRACT Context The duration of neuromuscular block with rocuronium is affected by old age as well as renal impairment. It would be helpful for anesthetists to know the variation in the block in elderly patients with renal failure and the significance of neuromuscular monitoring in this group. Aim The aim of our study is to investigate the neuromuscular effects of 0.6 mg/kg rocuronium under general anesthesia in young adults and elderly patients with or without renal failure. Study design Prospective randomized controlled study. Materials and methods Young and elderly 100 patients were divided into 4 groups of 25 each, with or without renal failure. General anesthesia with propofol 2 mg kg intravenous (iv), fentanyl 2 μg kg iv, and 60% N2O in O2 were given. Neuromuscular monitoring was started immediately after the induction of anesthesia and before the administration of muscle relaxant. After the stabilization of control responses, 0.6 mg kg rocuronium was injected intravenously. The onset time, time to achieve maximum block, and the recovery times were noted. Statistical analysis used The statistical analysis of the data from the study was performed with the Statistical Package for the Social Sciences (SPSS) software for Window Release 14.0. One-way analysis of variance, Bonferroni's, and chi-square test were used to compare patients’ characteristics. Results The duration of block as well as the recovery indices were significantly prolonged in the elderly compared to the young patients. Maximum prolongation was observed in the elderly group with renal failure. This underlines the importance of neuromuscular monitoring in these patients. How to cite this article Gvalani SK, Pradeep L. Comparison of Neuromuscular Blockade with Rocuronium in Young and Elderly Patients with or without Renal Failure. Res Inno in Anesth 2016;1(2):45-51.

scholarly journals Research on multifunctional beds for behavioral disorders in the elderly

2020 ◽  
Vol 189 ◽  
pp. 03036
Author(s):  
Zeng Xi ◽  
Yi Mengdi
Keyword(s):  
Elderly Patients ◽  
Medical Treatment ◽  
Body Movement ◽  
The Elderly ◽  
Passive Movement ◽  
Movement Behavior ◽  
Medical Environment ◽  
Hospital Beds ◽  
Observation Method ◽  
Rehabilitation Needs

Objective Through the redesign of hospital beds, we seek better ways for elderly patients to encounter various problems due to physical mobility disorder, and to solve elderly patients, especially elderly patients with severe physical activities, in medical treatment and daily care. Methods Taking the treatment and rehabilitation needs of elderly patients as the design direction and ergonomics as the design standard, the observation method, investigation method and scenario analysis method are used to analyze the active and passive migration of elderly patients in the medical environment. The behavioral needs and behavioral state were recorded, evaluated and analyzed, and the actual problems and causes of the elderly patients due to physical movement were analyzed with the purpose and path of the behavior as clues. Conclusion Through the redesign of hospital beds, we can solve all kinds of problems that elderly patients encounter because of their body movement disorder in the process of seeking medical treatment, avoid secondary injury caused by inappropriate active or passive movement behavior of elderly patients, improve the safety and comfort of elderly patients in the process of seeking medical treatment and rehabilitation, and improve hospital doctors at the same time.

scholarly journals Use of intravenous lidocaine for dose reduction of propofol in paediatric colonoscopy patients: a randomised placebo-controlled study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Wenshui Yao ◽  
Longxin Zhang ◽  
Guolin Lu ◽  
Jing Wang ◽  
Li Zhang ◽  
...  
Keyword(s):  
Visceral Pain ◽  
Controlled Study ◽  
Control Group ◽  
Intravenous Lidocaine ◽  
Lidocaine Group ◽  
The Awakening ◽  
Initial Plasma ◽  
Cardiopulmonary Complications ◽  
Recovery Times ◽  
Index Value

Abstract Background Propofol, a widely used sedative in endoscopic procedures, sometimes causes cardiopulmonary complications. Intravenous lidocaine can diminish visceral pain and decrease the dose of propofol. The purpose of this study was to assess the efficacy and safety of intravenous lidocaine in reducing propofol dosage during paediatric colonoscopy. Methods Forty children who underwent colonoscopy were divided into two groups. Lidocaine hydrochloride (1.5 mg/kg induction and 2 mg/kg/h maintenance) was given intravenously to the lidocaine group, and the same amount of saline was given to the control group after they received lidocaine induction. Propofol initial plasma concentration of 5 μg/mL was targeted, and the procedure was performed after the bispectral index value reached 55. The primary outcome was propofol requirement. Results The propofol requirement in the lidocaine group was decreased by 35.5% (128.6 ± 30.4 mg vs. 199.4 ± 57.6 mg; p < 0.001; 95%CI: − 100.60, − 41.02). The incidence of involuntary body movements was significantly lower in the lidocaine group (p = 0.028; OR = 0.17; 95%CI: 0.03, 0.92). The awakening time (p < 0.001; 95%CI: − 7.67, − 5.13) and recovery times (p < 0.001; 95%CI: − 7.45, − 4.35) were significantly lower in the lidocaine group. Pain was significantly less at 30 min and 60 min after the procedure in the lidocaine group (0 [0–4] vs. 3 [0–5], p < 0. 001; 0 [0–2] vs. 1 [0–3], p = 0.001). There was no difference in the incidence of bradycardia, hypotension, or hypoxia between the two groups. Conclusions For colonoscopy procedures in paediatric patients, intravenous lidocaine reduces the amount of propofol needed, provides better sedation and postprocedural pain management, as well as a reduction in recovery time. Trial registration The trial was registered on November 6, 2020 at China Clinical Trials Registration Center (www.chictr.org.cn) ref.: ChiCTR 2,000,039,706.

scholarly journals Effects of Intraoperative Dexamethasone and Ondansetron on Postoperative Nausea and Vomiting in Microvascular Decompression Surgery: A Randomized Controlled Study

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Cattleya Thongrong ◽  
Patitha Chullabodhi ◽  
Pornthep Kasemsiri ◽  
Amnat Kitkhuandee ◽  
Narin Plailaharn ◽  
...  
Keyword(s):  
Normal Saline ◽  
Microvascular Decompression ◽  
Postoperative Nausea ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Controlled Study ◽  
Control Group ◽  
Decompression Surgery ◽  
Microvascular Decompression Surgery ◽  
Double Blinded

Background. Postoperative nausea and vomiting (PONV) is a common problem and may lead to catastrophic complications, especially in neurosurgical cases. The aim of this study was to evaluate the effects of dexamethasone and ondansetron for preventing PONV in patients who underwent microvascular decompression (MVD) surgery. Methods. A prospective, double-blinded, randomized control trial was conducted with 54 patients who underwent MVD. Patients were allocated into two groups. The study group (Gr. D) received intraoperative dexamethasone 4 mg iv and ondansetron 4 mg iv, whereas the control group (Gr. N) received placebo (0.9% normal saline 1 ml iv and 0.9% normal saline 2 ml iv). The incidence and severity of PONV were observed at 1, 2, 4, and 24 hr postsurgery. Results. At 1, 2, 4, and 24 hr postsurgery, Gr. D had a lower incidence (7.4%, 11.1%, 29.6%, and 66.7%) and lower severity of PONV than Gr. N (18.5%, 29.6%, 37.0%, and 81.5% at 1, 2, 4, and 24 hr; p>0.05). The requirement for antiemetic drugs was not significantly different between the groups (p>0.05). Conclusion. Administration of dexamethasone and ondansetron 4 mg seemed to decrease the incidence of PONV in the first 24 hours but not significantly. Therefore, further studies are to be carried out by escalating either dexamethasone dose or the dose of ondansetron or both.

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