scholarly journals Evaluation of the Efficacy of Low-Dose Naloxone for the Prevention of Acute Remifentanil-Induced Hyperalgesia in Patients Undergoing General Anesthesia for Laparotomy

2020 ◽  
Vol 7 (4) ◽  
Author(s):  
Jalil Makarem ◽  
Hossein Majedi ◽  
Fateme Bahmaee ◽  
Seyed Mohammad Mireskandari ◽  
Fatemeh Amraei ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Low Dose ◽  
Major Complication ◽  
Concomitant Administration ◽  
Remifentanil Infusion ◽  
Morphine Dose ◽  
Post Surgery ◽  
Significant Difference ◽  
Opioid Administration ◽  
American Society

Background: Hyperalgesia is a major complication of continuous or intermittent opioid administration. The evidence suggests that concomitant administration of low-dose naloxone could prevent the development of acute opioid-induced hyperalgesia, with no effect on pain control. Objectives: The current study aimed to assess the effects of intraoperative low-dose naloxone, adding to remifentanil infusion on preventing acute postoperative hyperalgesia in patients undergoing general anesthesia for laparotomy. Methods: In this randomized clinical trial, patients undergoing general anesthesia for laparotomic hysterectomy in a tertiary referral teaching hospital from February to December 2019 were randomly assigned to one of three groups of remifentanil-naloxone (remifentanil 0.3 μg/ kg/min with low-dose naloxone 0.25μg/kg /h prepared in 50 mL of normal saline), remifentanil (0.3 μg/kg/min), and control (receiving 50 mL saline infusion), intraoperatively. Patients and researchers were blinded to the type of intervention. The severity of hyperalgesia, as the main outcome, was evaluated by the static Tactile test. The severity of pain was assessed by visual analogous scale 0.5, 2, 6, 12, and 24 hours after surgery. Results: In total, 75 patients were evaluated. The results showed no difference concerning the independent variables (age, body mass index, hypertension, surgery duration, anesthesia duration, and American Society of Anesthesiologists (ASA) class) between the three groups. Heart rate was significantly different in all study time points between the three groups (P < 0.001), but mean arterial pressure and systolic and diastolic blood pressure showed no significant difference (P > 0.05) throughout the study. Assessment of hyperalgesia using the tactile test revealed a higher incidence of hyperalgesia in the remifentanil group in 0.5, 2, 6, 12, and 24 hours after surgery compared to the other two groups, which was statistically significant between the groups at 0.5, 2, and 6 hours after surgery (P < 0.05). Shivering incidence, Morphine dose in 24 hours post-surgery, morphine dose in the recovery room, and VAS for pain were significantly different during the study between the three groups (P < 0.05). Conclusions: This study demonstrated the efficacy of intraoperative low-dose naloxone (0.25 μg/kg/h) added to remifentanil infusion on reducing the frequency and severity of acute postoperative hyperalgesia in patients undergoing general anesthesia for laparotomy hysterectomy.

scholarly journals Comparative study of fentanyl versus tramadol as adjuvant with low dose local anaesthetic ropivacaine (0.1%) for epidural labour analgesia

2020 ◽  
Vol 8 (9) ◽  
pp. 3309
Author(s):  
Aman Choudhary ◽  
Sakshi Maheshwari ◽  
Naveen Paliwal ◽  
Shobha Ujwal ◽  
Geeta Singariya
Keyword(s):  
Side Effects ◽  
Low Dose ◽  
International Association ◽  
Labour Analgesia ◽  
Arterial Blood ◽  
Physical Status Classification ◽  
Significant Difference ◽  
Ethical Committee Approval ◽  
American Society ◽  
Double Blinded

Background: Toxonomy committee of International Association defined pain as an unpleasant emotional and sensory experience associated with potential tissue damage. The present study was conducted to evaluate the effect of a combination of low dose ropivacaine with fentanyl and tramadol in epidural labour analgesia.Methods: This prospective randomized double blinded clinical study was conducted in 100 patients in labour after ethical committee approval. Inclusion criteria was patients who had ASA I and ASA II (American society of anesthesiologists physical status classification system), age above 18 years, height more than 150 cm, weight less than 110 kg, either primigravidae or gravid 2. Patients were allocated into two groups Group F (ropivacaine with fentanyl) and group T (ropivacaine with tramadol) by computer generated randomisation technique.Results: In the present study, mean age in group F (ropivacaine with fentanyl) was 22.54±2.5, mean age in group T (ropivacaine with tramadol) was 22.86±2.17, and weight in group F was 56.68±2.75 and group T was 56.58±2.58. Duration of labour in group F was 3.39±1.01 hrs and in group T was 3.42±0.70 hrs. There was no significant difference between the two groups at any time points for mean VAS score. There was no significant difference in the mean heart rate and arterial blood pressure among both the groups statistically (P>0.05). More side effects were seen in group F.Conclusions: Both fentanyl and tramadol in combination with ropivacaine provide similar analgesia with minimal motor block. Both have no adverse effects on cardiotocographic parameters. However side effects were relatively more common in fentanyl group. Thus tramadol is a safer alternative to fentanyl as an adjunct to epidural labour analgesia.

scholarly journals Thoracic Paravertebral Nerve Block with Ropivacaine and Adjuvant Dexmedetomidine Produced Longer Analgesia in Patients Undergoing Video-Assisted Thoracoscopic Lobectomy: A Randomized Trial

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Jun Zha ◽  
Shiliang Ji ◽  
Chen Wang ◽  
Zhe Yang ◽  
Shigang Qiao ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Nerve Block ◽  
Single Point ◽  
Anesthesia Induction ◽  
Patient Controlled Analgesia ◽  
Video Assisted ◽  
Thoracoscopic Lobectomy ◽  
Significant Difference ◽  
American Society ◽  
The Times

Purpose. This study evaluated the postoperative analgesic effect of ultrasound-guided single-point thoracic paravertebral nerve block (TPVB) combined with dexmedetomidine (DEX) in patients undergoing video-assisted thoracoscopic lobectomy. Methods. Sixty adult patients of the American Society of Anesthesiologists (ASA) I–III were randomly assigned into three groups (n = 20 each). G group: patients received routine general anesthesia; PR group: patients received 0.5% ropivacaine; and PRD group: patients received 0.5% ropivacaine with 1 μg/kg DEX. TPVB was performed in the T5 space before surgery, and then, general anesthesia induction and video-assisted thoracoscopic lobectomy were performed. Analgesics were administered through the patient-controlled analgesia (PCA) device intravenously. The background infusion of each PCA device was set to administer 0.02 μg/kg/h sufentanil, with a lockout time of 15 min, and a total allowable volume is 100 ml. Results. Compared to PR and G groups, the total sufentanil consumption after operation, the times of analgesic pump pressing, the pain score, and the incidence of postoperative nausea or vomiting in the PRD group were significantly reduced ( p < 0.05 ). Also, the duration of first time of usage of the patient-controlled analgesia (PCA) was longer. The heart rate (HR) and mean arterial pressure (MAP) during operation were lower in the PRD group as compared with the other two groups in most of the time. However, hypotension and arrhythmia occurred in three groups with no statistically significant difference. Conclusions. A small volume of TPVB with ropivacaine and DEX by single injection produced longer analgesia in patients undergoing video-assisted thoracoscopic lobectomy, reduced postoperative opioids consumption, and the incidence of side effects.

scholarly journals Effect of remifentanil infusion on the hemodynamic response during induction of anesthesia in hypertensive and normotensive patients: a prospective observational study

2019 ◽  
Vol 47 (12) ◽  
pp. 6254-6267
Author(s):  
Soo Kyung Lee ◽  
Mi Ae Jeong ◽  
Jeong Min Sung ◽  
Hyo Jin Yeon ◽  
Ji Hee Chang ◽  
...  
Keyword(s):  
Heart Rate ◽  
General Anesthesia ◽  
Prospective Observational Study ◽  
Hemodynamic Response ◽  
Hemodynamic Instability ◽  
Remifentanil Infusion ◽  
Significant Difference ◽  
Blood Pressures ◽  
Post Intubation ◽  
Time Point

Background The induction of general anesthesia may cause hemodynamic instability. Remifentanil is often administered to suppress the hemodynamic response. We aimed to evaluate the effect of remifentanil infusion on the hemodynamic response to induction of anesthesia in hypertensive and normotensive patients. Methods Patients were divided into two groups: Group H (n = 102) were hypertensive patients and Group C (n = 107) were normotensive patients. During induction, all patients received 1 µg/kg of remifentanil as a loading dose over 2 minutes, followed by a continuous infusion at 0.05 µg/kg/minute. We analyzed the systolic, diastolic, and mean pressures and heart rate pre-induction, pre-intubation, immediately post-intubation, and at 2, 4, 6, 8, and 10 minutes after intubation. Results The systolic, diastolic, and mean pressures before induction were significantly higher in group H compared with group C, but there was no significant difference between the two groups immediately after intubation. Blood pressures immediately after intubation were similar to the pre-induction blood pressure. There was no significant difference in heart rate between the two groups at any time point. Conclusions Remifentanil infusion effectively attenuates the hemodynamic response to induction of general anesthesia in hypertensive and normotensive patients.

scholarly journals NEURAXIAL ANESTHESIA FOR HIP ARTHROSCOPY IS ASSOCIATED WITH DECREASED IMMEDIATE POSTOPERATIVE PAIN SCORES AND OPIOID REQUIREMENTS COMPARED TO GENERAL ANESTHESIA

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0003
Author(s):  
Elizabeth H. G. Turner ◽  
Christopher J. Whalen ◽  
Matthew A. Beilfuss ◽  
Scott J. Hetzel ◽  
Kristopher M. Schroeder ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Adverse Events ◽  
General Anesthesia ◽  
Hip Arthroscopy ◽  
Neuraxial Anesthesia ◽  
Pain Scores ◽  
Significant Difference ◽  
Opioid Administration ◽  
Spinal Epidural ◽  
Major Adverse Events

Background: Hip arthroscopy is most commonly performed utilizing general anesthesia. Studies in hip and knee arthroplasty have shown an association between neuraxial anesthesia and lower rates of perioperative adverse events, lower post-operative pain scores, and lower dosing of postoperative systemic analgesics when compared to general anesthesia. A direct comparison between neuraxial and general anesthesia in hip arthroscopy has not previously been investigated. Hypothesis/Purpose: We sought to identify the immediate post-operative differences in opioid use, pain scores, and post-anesthesia care unit (PACU) length of stay (LOS) after hip arthroscopy related to the type of anesthesia used for the surgical procedure. Methods: Patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS) with labral tears by a single surgeon at an academic center between October 2017 and July 2019 were retrospectively reviewed. The primary outcome was PACU opioid administration, measured by morphine equivalents (MEQ). Secondary parameters included total LOS, post-incision LOS, PACU LOS and PACU arrival/discharge pain scores. Analyses conducted were t-tests, Wilcoxon rank sum tests, or chi-square tests. Results: A total of 129 patients met inclusion criteria for this study; 54 males and 75 females, with an average age of 28 (±10.1) years. 52 (40.3%) had general anesthesia and 77 (59.7%) had neuraxial anesthesia, including spinal, epidural, and combined spinal-epidural anesthesia which were intermixed throughout the study period. Intraoperative and PACU opioid administration demonstrated a significant difference in medians. Neuraxial methods required a lower MEQ in both the operating room (30.0 vs 53.9, p = 0.001) and PACU (18.2 vs 31.2, p = 0.002). Neuraxial anesthesia had lower median PACU arrival and discharge pain scores (0.0 vs. 5.0, p = 0.001, 3.0 vs. 4.0, p = 0.013). There was no statistically significant difference in post-incision LOS, or traction time. General anesthesia was associated with a longer PACU phase 1 time (1.0 vs. 1.3 hrs, p = 0.005). No major adverse events such as death, disability, or prolonged hospitalization occurred in either group. Conclusion: Neuraxial anesthesia use in routine hip arthroscopy was associated with lower immediate postoperative pain scores, lower intraoperative and immediate postoperative opioid requirements, and may be associated with shorter anesthesia recovery time without any major adverse events when compared to general anesthesia. Tables [Table: see text][Table: see text]

scholarly journals Spinal Anesthesia is Safe and Cost-effective for Laparoscopic Appendectomy in Children: A Case-Control Study (Preprint)

2020 ◽  
Author(s):  
Md Jafrul Hannan ◽  
Mosammat Kohinnor Parveen ◽  
Alak Nandy ◽  
Md Samiul Hasan
Keyword(s):  
General Anesthesia ◽  
Spinal Anesthesia ◽  
Hospital Costs ◽  
Cost Effective ◽  
Patient Comfort ◽  
Hospital Discharges ◽  
Operation Theatre ◽  
Post Surgery ◽  
Significant Difference ◽  
Control Study

BACKGROUND to the widespread use of general anesthesia, administration of spinal anesthesia in pediatrics is not widely practiced. Yet there is ample positive evidence demonstrating its safety, effectiveness and success. OBJECTIVE The objective of this study is to demonstrate that laparoscopic appendectomies are successful under spinal anesthesia and elicit clear advantages over general anesthesia. METHODS This was a retrospective analysis of 77 pediatric (5-8 year old) laparoscopic appendectomies that took place in a Hospital in Chittagong, Bangladesh in 2019. Approximately half of the patients underwent spinal anesthesia while the other half underwent general anesthesia. Variables such as surgery and operation theatre times, pain score, incidence of post-surgery vomiting, analgesic usage, discharge times and hospital costs were recorded. Statistical analysis was used to analyze the data as a function of form of anesthesia. RESULTS The probability of vomiting when using spinal compared to general anesthesia was much lower within the first 5 hours (P < .001) and after 6 hours (P = .008) of operation. Highly significant difference (P < .001) was observed in the total costs of the procedures. A significantly higher likelihood of patients being discharged the same day of the procedure was noted if spinal anesthesia was used (P = .008). CONCLUSIONS Spinal anesthesia is superior to general anesthesia for pediatric laparoscopic appendectomies. Patient comfort is improved through a significant decrease in vomiting. This enables more rapid hospital discharges and a significant cost saving, without compromising the outcome of the procedure.

Rapid Sequence Spinal Anesthesia Vs General Anesthesia for Category-I Urgency Caesarean Section

2018 ◽  
Vol 3 (01) ◽  
Author(s):  
Dr. Ravi Gurvani ◽  
Dr. Dharam Veer Chandrakar
Keyword(s):  
Caesarean Section ◽  
General Anesthesia ◽  
Spinal Anesthesia ◽  
Pregnancy Termination ◽  
P Value ◽  
Group I ◽  
Rapid Sequence ◽  
Significant Difference ◽  
American Society ◽  
American Society Of Anesthesiologists

Aims of study - Rapid Sequence spinal anesthesia Vs general anesthesia for category-I urgency caesarean section. Background - Pregnancy termination by caesarean section (CS) is rapidly increasing all over the world. Hence, it has increasingly become a greater challenge to provide care for the parturient, but this has given obstetric anesthetists a greater opportunity to contribute to obstetric services. While caesarean deliveries were historically performed using general anaesthesia, there is a recent significant move towards regional anaesthesia. Materials and Methods - As per American Society of Anesthesiologists physical status (ASAPS) I 50 patients of category 1 were included in this study and divided into two equal groups, 25 in each group. Group I received GA and group II received RSSA. Result - Time for anesthesia was more in the RSGA group than the RSSA group, which was statistically significant (P < 0.001). The time for surgical readiness was also significantly higher in the RSGA group in comparison to the RSSA group with P value of < 0.001, which was statistically significant but there was no significant difference in Incision to delivery time.

scholarly journals The effect of low dose pethidine and diazepam for sedation in Cesarean Section under Sub-Arachnoid Block on mothers’ satisfaction

1970 ◽  
Vol 24 (1) ◽  
pp. 10-13
Author(s):  
Dilip Kumar Saha ◽  
Mazibar Rahman ◽  
Paresh Chandra Sarkar ◽  
Debasish Banik ◽  
Quamrul Hudaak ◽  
...  
Keyword(s):  
Cesarean Section ◽  
General Anesthesia ◽  
Low Dose ◽  
Cross Sectional Study ◽  
P Value ◽  
Chi Square ◽  
Cross Sectional ◽  
Chi Square Test ◽  
American Society ◽  
Sedation Group

Objective: Cesarean Section (CS) is usually performed when a vaginal delivery would put the baby's or mother's life at risk. Regional anesthesia has the advantage over general anesthesia by allowing mother to remain awake during operation. However, some women prefer general anesthesia as they want to be asleep during the operation. Aim of our study was to see the effect of mild sedation on mothers' satisfaction during CS.Materials and methods: A prospective cross sectional study was undertaken in the department of Anesthesiology, Institute of Child and Mother Health from January 2009 to December 2009. Sixty patients of singletone pregnancy with ASA(American Society of Anesthesiology)-I were randomized into two groups I&II of which one group received sedation with low dose pethidine and diazepam and other group did not get any sedation.Results: Data were analyzed between the groups and within the groups using students'‘t' test and Chi-Square test. A p-value of <0.05 was considered as significant. Patient's parameters like heart rate and blood pressure were not statistically significant between groups, but SpO2 fall was statistically significant. Mother's satisfaction is significantly high (76%) in sedation group than non sedation group.Conclusion: By sedation with low dose pethidine and diazepam, mothers' satisfaction was better achieved without affecting the hemo-dynamic stability. Keywords: sedation; cesarean section; sub-arachnoid block; mothers' satisfaction. DOI: 10.3329/bjog.v24i1.6320 Bangladesh J Obstet Gynaecol, 2009; Vol. 24(1) : 10-13

scholarly journals Spinal Anesthesia is Safe and Cost-effective for Laparoscopic Appendectomy in Children: A Case-Control Study

2020 ◽  
Author(s):  
Md Jafrul Hannan ◽  
Mosammat Kohinoor Parveenl ◽  
Alak Nandy ◽  
Md Samiul Hasan
Keyword(s):  
General Anesthesia ◽  
Spinal Anesthesia ◽  
Hospital Costs ◽  
Cost Effective ◽  
Patient Comfort ◽  
Controlled Study ◽  
Hospital Discharges ◽  
Retrospective Case ◽  
Post Surgery ◽  
Significant Difference

STRUCTURED ABSTRACTBackgroundOwing to the widespread use of general anesthesia, administration of spinal anesthesia in pediatrics is not widely practiced. Yet there is ample positive evidence demonstrating its safety, effectiveness and success.ObjectiveThe objective of this study is to demonstrate that laparoscopic appendectomies are successful under spinal anesthesia and elicit clear advantages over general anesthesia.MethodsThis was a retrospective analysis of 77 pediatric (5-8 year old) laparoscopic appendectomies that took place in a Hospital in Chittagong, Bangladesh in 2019. Approximately half of the patients underwent spinal anesthesia while the other half underwent general anesthesia. Variables such as surgery and operation theatre times, pain score, incidence of post-surgery vomiting, analgesic usage, discharge times and hospital costs were recorded. Statistical analysis was used to analyze the data as a function of form of anesthesia.ResultsThe probability of vomiting when using spinal compared to general anesthesia was much lower within the first 5 hours (P < .001) and after 6 hours (P = .008) of operation. Highly significant difference (P < .001) was observed in the total costs of the procedures. A significantly higher likelihood of patients being discharged the same day of the procedure was noted if spinal anesthesia was used (P = .008).ConclusionsSpinal anesthesia is superior to general anesthesia for pediatric laparoscopic appendectomies. Patient comfort is improved through a significant decrease in vomiting. This enables more rapid hospital discharges and a significant cost saving, without compromising the outcome of the procedure.MINI-ABSTRACTSpinal anesthesia is seldom used for laparoscopy in children. This retrospective case-controlled study compared spinal anesthesia with general anesthesia in children between 5 and 8 years of age. Spinal anesthesia proved to be safer and cost-effective for laparoscopy in children.

scholarly journals Preemptive Effect of Two Different (Intracuff and Intravenous) Routes of Dexamethasone Administration on Postoperative Sore Throat and Cough

2019 ◽  
Vol 4 (2) ◽  
Author(s):  
Nedasadat Mansouritehrani
Keyword(s):  
Clinical Trial ◽  
General Anesthesia ◽  
Sore Throat ◽  
Postoperative Sore Throat ◽  
The Third ◽  
Hemodynamic Variables ◽  
Post Surgery ◽  
Significant Difference ◽  
Hoarse Voice ◽  
Preemptive Effect

Introduction: The most common complications following anesthesia intubation include postoperative sore throat, post-extubation cough, and hoarse voice. Currently, the use of preoperative Dexamethasone has been effective in controlling these complications. Therefore, the present study aimed to compare the preemptive effect of intracuff and intravenous routes of Dexamethasone administration for postoperative sore throat and cough. Materials and Methods: In the present clinical trial, 96 patients who underwent general anesthesia intubation were randomly assigned to three groups. The first group received 4 mg intracuff Dexamethasone, the second group received 4 mg intravenous Dexamethasone, and the third group was administered a placebo. Cough frequency and severity of a sore throat after extubation were investigated in the three groups. Results: Any significant difference was not observed among the three groups regarding hemodynamic variables (P>0.01); however, the incidence of cough was significantly lower in all the three groups (P<0.01). Also, the average severity of a sore throat in PAR and 1 h after surgery in the three groups was significantly lower (P<0.05). Moreover, no difference was detected in the groups regarding the severity of a sore throat within 24 h post-surgery (P>0.01). Conclusion: The use of two methods of intravenous and intracuff Dexamethasone administration before surgery reduced the incidence of postoperative cough and the severity of sore throat in patients.

Restaging of patients with lymphoma

2008 ◽  
Vol 47 (01) ◽  
pp. 37-42 ◽  
Author(s):  
T. Pfluger ◽  
V. Schneider ◽  
M. Hacker ◽  
N. Bröckel ◽  
D. Morhard ◽  
...  
Keyword(s):  
Low Dose ◽  
Non Hodgkin Lymphoma ◽  
Contrast Enhanced ◽  
Pet Ct ◽  
Significant Difference ◽  
18F Fdg ◽  
Sensitivity Specificity ◽  
Fdg Pet Ct

SummaryAim: Assessment of the clinical benefit of i.v. contrast enhanced diagnostic CT (CE-CT) compared to low dose CT with 20 mAs (LD-CT) without contrast medium in combined [18F]-FDG PET/CT examinations in restaging of patients with lymphoma. Patients, methods: 45 patients with non-Hodgkin lymphoma (n = 35) and Hodgkin's disease (n = 10) were included into this study. PET, LD-CT and CECT were analyzed separately as well as side-by-side. Lymphoma involvement was evaluated separately for seven regions. Indeterminate diagnoses were accepted whenever there was a discrepancy between PET and CT findings. Results for combined reading were calculated by rating indeterminate diagnoses according the suggestions of either CT or PET. Each patient had a clinical follow-up evaluation for >6 months. Results: Region-based evaluation suggested a sensitivity/specificity of 66/93% for LD-CT, 87%/91% for CE-CT, 95%/96% for PET, 94%/99% for PET/LD-CT and 96%/99% for PET/CE-CT. The data for PET/CT were obtained by rating indeterminate results according to the suggestions of PET, which turned out to be superior to CT. Lymphoma staging was changed in two patients using PET/ CE-CT as compared to PET/LD-CT. Conclusion: Overall, there was no significant difference between PET/LD-CT and PET/CE-CT. However, PET/CE-CT yielded a more precise lesion delineation than PET/LD-CT. This was due to the improved image quality of CE-CT and might lead to a more accurate investigation of lymphoma.

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