Ultimo Aggiornamento: Agosto 2001

Anaesth Intensive Care 2001 Apr;29(2):149-54

Tramadol for postoperative shivering: a double-blind comparison with pethidine.

Bhatnagar S, Saxena A, Kannan TR, Punj J, Panigrahi M, Mishra S

Unit of Anesthesiology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Ansani Nagar, New Delhi.

In most operating and recovery rooms, shivering is controlled by the use of humidifiers, warming blankets, and inhalation of humidified heated oxygen. However, pharmacological control is an effective alternate treatment modality. This randomized, double-blind trial, conducted in 30 ASA Grade 1 or 2 patients, was designed to explore the efficacy of tramadol and pethidine in the treatment of post-anaesthetic shivering. Tramadol is an inhibitor of the re-uptake of serotonin (5-hydroxytryptamine) and norepinephrine in the spinal cord. This facilitates 5-hydroxytryptamine release, which influences thermoregulatory control. We compared the efficacy of tramadol with that of pethidine, presently a widely used drug for the control of shivering. Patients received either tramadol 1 mg/kg or pethidine 0.5 mg/kg intravenously and the grade of shivering, pulse rate, blood pressure and respiratory rate were observed every 10 minutes after injection for one hour Shivering was significantly more likely to have ceased in the tramadol group (12 of 15 versus 4 of 15 cases, P<0.05) at 10 minutes after drug administration and this control was better sustained. No patients receiving tramadol had a recurrence of shivering. It is concluded that intravenous tramadol 1 mg/kg is more effective for the treatment of postoperative shivering than pethidine 0.5 mg/kg.

Publication Types:

Clinical trial
Randomized controlled trial

PMID: 11314834, UI: 21209788

Anesth Analg 2001 Sep;93(3):793-7

Fourteenth annual meeting of the society for pediatric anesthesia, san francisco, california, october 13, 2000.

Kern F

Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina.

[Medline record in process]

PMID: 11524359, UI: 21415339

Anesth Analg 2001 Sep;93(3):787-90

The pressor response and airway effects of cricoid pressure during induction of general anesthesia.

Saghaei M, Masoodifar M

Department of Anesthesia and Critical Care, Isfahan University of Medical Sciences, Isfahan, Iran.

[Medline record in process]

Cricoid pressure (CP) has been used to protect the patient from regurgitation and gastric insufflation. Because the hemodynamic effects of CP have not been evaluated independently, we designed this prospective study. Eighty ASA I adult patients were prospectively included in the study. Patients were randomly divided into Cricoid and Placebo groups. In the Cricoid group, after the induction of anesthesia, bimanual CP was performed, and in the Control group, simple placement of hands without exerting pressure was performed. Peak inspiratory pressure and exhaled tidal volume were recorded before and during the application of CP. Arterial blood pressure and heart rate were recorded before and after application of CP. The data were compared between and within groups by using the mixed-design analysis of variance. Peak inspiratory pressure increased and tidal volume decreased significantly after the application of CP compared with the Control group and baseline values. Arterial blood pressure and heart rate increased significantly after the application of CP compared with the baseline values and with those of the Control group. The result of this study shows that CP can cause a relatively strong pressor response. IMPLICATIONS: Cricoid pressure is used for prevention of gastric regurgitation under general anesthesia. We found that cricoid pressure can increase the blood pressure and heart rate significantly.

PMID: 11524357, UI: 21415337

Anesth Analg 2001 Sep;93(3):734-42

The Efficacy of Epinephrine or Vasopressin for Resuscitation During Epidural Anesthesia.

Krismer AC, Hogan QH, Wenzel V, Lindner KH, Achleitner U, Oroszy S, Rainer B, Wihaidi A, Mayr VD, Spencker P, Amann A

Department of Anesthesiology and Critical Care Medicine, Leopold-Franzens-University of Innsbruck, Austria.

[Medline record in process]

Cardiopulmonary resuscitation (CPR) during epidural anesthesia is considered difficult because of diminished coronary perfusion pressure. The efficacy of epinephrine and vasopressin in this setting is unknown. Therefore, we designed this study to assess the effects of epinephrine versus vasopressin on coronary perfusion pressure in a porcine model with and without epidural anesthesia and subsequent cardiac arrest. Thirty minutes before induction of cardiac arrest, 16 pigs received epidural anesthesia with bupivacaine while another 12 pigs received only saline administration epidurally. After 1 min of untreated ventricular fibrillation, followed by 3 min of basic life-support CPR, Epidural Animals and Control Animals randomly received every 5 min either epinephrine (45, 45, and 200 &mgr;g/kg) or vasopressin (0.4, 0.4, and 0.8 U/kg). During basic life-support CPR, mean +/- SEM coronary perfusion pressure was significantly lower after epidural bupivacaine than after epidural saline (13 +/- 1 vs 24 +/- 2 mm Hg, P < 0.05). Ninety seconds after the first drug administration, epinephrine increased coronary perfusion pressure significantly less than vasopressin in control animals without epidural block (42 +/- 2 vs 57 +/- 5 mm Hg, P < 0.05), but comparably to vasopressin after epidural block (45 +/- 4 vs 48 +/- 6 mm Hg). Defibrillation was attempted after 18 min of CPR. After return of spontaneous circulation, bradycardia required treatment in animals receiving vasopressin, especially with epidural anesthesia. Systemic acidosis was increased in animals receiving epinephrine than vasopressin, regardless of presence or absence of epidural anesthesia. We conclude that vasopressin may be a more desirable vasopressor for resuscitation during epidural block because the response to a single dose is longer lasting, and acidosis after multiple doses is less severe compared with epinephrine. IMPLICATIONS: We evaluated the effects of repeated dosages of epinephrine versus vasopressin in a porcine cardiac arrest model with epidural anesthesia. Both epinephrine and vasopressin increased coronary perfusion pressure sufficiently in this setting. Vasopressin may be more desirable during epidural block because the response to a single dose is longer lasting and because acidosis after multiple doses is less severe compared with epinephrine.

PMID: 11524349, UI: 21415329

Anesth Analg 2001 Sep;93(3):703-8

Metaraminol infusion for maintenance of arterial blood pressure during spinal anesthesia for cesarean delivery: the effect of a crystalloid bolus.

Ngan Kee WD, Khaw KS, Lee BB, Wong MM, Ng FF

Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China.

[Medline record in process]

We randomly allocated women having elective cesarean delivery to receive either no bolus (Control Group, n = 31) or 20 mL/kg lactated Ringer's solution (Bolus Group, n = 35) IV before spinal anesthesia. An infusion of metaraminol started at 0.25 mg/min was titrated to maintain systolic arterial blood pressure in the target range 90%-100% of baseline. The total dose of metaraminol required up to the time of uterine incision was similar between the Control Group and the Bolus Group (3.62 +/- 1.20 vs 3.27 +/- 1.39 mg, P = 0.3). However, the Control Group required more metaraminol in the first 5 min (1.29 +/- 0.60 vs 0.96 +/- 0.58 mg, P = 0.025) and a faster maximum infusion rate (0.45 +/- 0.20 vs 0.32 +/- 0.13 mg/min, P = 0.002) compared with the Bolus Group. There was no difference between groups in regards to changes in systolic arterial blood pressure or heart rate over time, or maternal or neonatal outcome. We conclude that when metaraminol is used to maintain arterial pressure during spinal anesthesia for cesarean delivery, crystalloid bolus is not essential provided that sufficient vasopressor is given in the immediate postspinal period. IMPLICATIONS: In patients receiving spinal anesthesia for elective cesarean delivery, when arterial pressure was maintained using an IV infusion of metaraminol, crystalloid bolus reduced the early vasopressor requirement but had no effect on overall vasopressor requirement or maternal or neonatal outcome.

PMID: 11524344, UI: 21415324

Anesth Analg 2001 Sep;93(3):697-702

The Effects of Topical and Intravenous Ketamine on Cerebral Arterioles in Dogs Receiving Pentobarbital or Isoflurane Anesthesia.

Ohata H, Iida H, Nagase K, Dohi S

Department of Anesthesiology and Critical Care Medicine, Gifu University School of Medicine, Gifu City, Gifu 500-8705, Japan.

[Medline record in process]

To evaluate the effects of ketamine on cerebral arterioles, we used a closed cranial window technique in mechanically ventilated, anesthetized dogs. Fourteen dogs were assigned to one of the following two basal-anesthesia groups: pentobarbital 2 mg. kg(-1). h(-1) or isoflurane 0.5 MAC (n = 7 each). We administered three different concentrations of ketamine (10(-7), 10(-5), and 10(-3) M) under the window and measured arteriolar diameters. For comparison, in another 14 dogs we examined the effect of systemic (IV) ketamine (1 mg/kg and 5 mg/kg) using the same two basal anesthetics. We measured diameters before and after ketamine administration, and we evaluated the effect of ketamine on CO(2) reactivity of the cerebral arterioles. Neither topical nor systemic ketamine dilated pial arterioles in either basal-anesthesia group. CO(2) reactivity of pial arterioles was reduced under systemic ketamine in both basal-anesthesia groups. The results indicate that although ketamine does not dilate pial arteriolar diameters when topically or IV administered, IV ketamine does attenuate hypercapnic vasodilation in dogs under basal pentobarbital or isoflurane anesthesia. These results provide some insight that ketamine is suitable for supplementary neurosurgical anesthesia. IMPLICATIONS: In cerebral arterioles in dogs under pentobarbital or isoflurane anesthesia, neither topical nor IV ketamine induced vasodilation. However, IV ketamine did attenuate hypercapnia-induced vasodilation. These findings provide some insight into the safety and suitability of ketamine as a supplement for neurosurgical anesthesia.

PMID: 11524343, UI: 21415323

Anesth Analg 2001 Sep;93(3):613-9

The effect of bispectral index monitoring on end-tidal gas concentration and recovery duration after outpatient anesthesia.

Pavlin DJ, Hong JY, Freund PR, Koerschgen ME, Bower JO, Bowdle TA

Department of Anesthesiology, University of Washington School of Medicine, Seattle, Washington.

[Medline record in process]

We performed this study to determine whether instituting monitoring of bispectral index (BIS) throughout an entire operating room would affect end-tidal gas concentration (as a surrogate for anesthetic use) or speed of recovery after outpatient surgery. Primary caregivers (n = 69) were randomly assigned to a BIS or non-BIS Control group with cross-over at 1-mo intervals for 7 mo. Data were obtained in all outpatients except for those having head-and-neck surgery. Mean end-tidal gas concentration and total recovery duration were compared by unpaired t-test. Overall, 469 patients (80%) received propofol for induction and sevoflurane for maintenance. This homogeneous group was selected for statistical analysis. Mean end-tidal sevoflurane concentration was 13% less in the BIS group (BIS, 1.23%; Control, 1.41%; P < 0.0001); differences were most evident when anesthesia was administered by first-year trainees. Mean BIS values were 47 in the BIS-Monitored group. Total recovery was 19 min less with BIS monitoring in men (BIS group, 147 min; Controls, 166 min; P = 0.035), but not different in women. We conclude that routine application of BIS monitoring is associated with a modest reduction in end-tidal sevoflurane concentration. In men, this may correlate with a similar reduction (11%) in recovery duration. IMPLICATIONS: Adoption of Bispectral index monitoring throughout an entire operating room was associated with use of lesser concentrations of sevoflurane to maintain anesthesia and reduced recovery duration in men undergoing general anesthesia for ambulatory surgery.

PMID: 11524328, UI: 21415308

Anesth Analg 2001 Sep;93(3):560-5

A comparison of sevoflurane, target-controlled infusion propofol, and propofol/isoflurane anesthesia in patients undergoing carotid surgery: a quality of anesthesia and recovery profile.

Godet G, Watremez C, El Kettani C, Soriano C, Coriat P

Department of Anesthesiology, Pitie-Salpetriere Hospital, Paris, France.

[Medline record in process]

In a prospective randomized study in patients undergoing carotid endarterectomy, we compared the hemodynamic effects, the quality of induction, and the quality of recovery from a hypnotic drug for the induction of anesthesia with sevoflurane, a target-controlled infusion (TCI) of propofol, or propofol 1.5 &mgr;g/kg followed by isoflurane. All patients were premedicated with midazolam and received sufentanil 0.4 &mgr;g/kg at induction. The induction of anesthesia was associated with a decrease in arterial blood pressure in all groups, but this was least pronounced in the Sevoflurane group. There were similar a number of episodes of hypotension, hypertension, and tachycardia among groups, but the incidence of bradycardia was less in the TCI group (P < 0.05) compared with the other groups. The duration of episodes of hypotension was shorter (P < 0.05) in the TCI Propofol group (1.9 +/- 2.3 min) compared with the Sevoflurane group (4.7 +/- 3.6 min). The duration of episodes of bradycardia was significantly lower (P < 0.05) in the TCI Propofol group (0.1 +/- 0.5 min) in comparison with the Propofol Bolus group (2.5 +/- 3.9 min). Similar doses of vasoactive drugs were used in all groups. The induction of anesthesia with sevoflurane was associated with inferior conditions for intubation in comparison with both Propofol groups, although the time to intubation was faster in the Sevoflurane group (P < 0.05). The recovery characteristics were similar in the three groups. IMPLICATIONS: In patients undergoing carotid endarterectomy, the induction of anesthesia with sevoflurane, target-controlled infusion propofol, or propofol bolus is associated with a decrease in arterial blood pressure. Induction with sevoflurane is associated with inferior but faster conditions for intubation of the trachea. The recovery characteristics were similar in the three groups.

PMID: 11524318, UI: 21415298

Anesth Analg 2001 Sep;93(3):528-35

A prospective randomized study of the potential benefits of thoracic epidural anesthesia and analgesia in patients undergoing coronary artery bypass grafting.

Scott NB, Turfrey DJ, Ray DA, Nzewi O, Sutcliffe NP, Lal AB, Norrie J, Nagels WJ, Ramayya GP

Department of Anaesthesia and Intensive Care, HCI International Medical Centre, Clydebank, Scotland, United Kingdom.

[Medline record in process]

We performed an open, prospective, randomized, controlled study of the incidence of major organ complications in 420 patients undergoing routine coronary artery bypass graft surgery with or without thoracic epidural anesthesia and analgesia (TEA). All patients received a standardized general anesthetic. Group TEA received TEA for 96 h. Group GA (gen- eral anesthesia) received narcotic analgesia for 72 h. Both groups received supplementary oral analgesia. Twelve patients were excluded-eight in Group TEA and four in Group GA-because of incomplete data collection. New supraventricular arrhythmias occurred in 21 of 206 patients (10.2%) in Group TEA compared with 45 of 202 patients (22.3%) in Group GA (P = 0.0012). Pulmonary function (maximal inspiratory lung volume) was better in Group TEA in a subset of 93 patients (P < 0.0001). Extubation was achieved earlier (P < 0.0001) and with significantly fewer lower respiratory tract infections in Group TEA (TEA = 31 of 206, GA = 59 of 202; P = 0.0007). There were significantly fewer patients with acute confusion (GA = 11 of 202, TEA = 3 of 206; P = 0.031) and acute renal failure (GA = 14 of 202, TEA = 4 of 206; P = 0.016) in the TEA group. The incidence of stroke was insignificantly less in the TEA group (GA = 6 of 202, TEA = 2 of 206; P = 0.17). There were no neurologic complications associated with the use of TEA. We conclude that continuous TEA significantly improves the quality of recovery after coronary artery bypass graft surgery compared with conventional narcotic analgesia. IMPLICATIONS: Many anesthesiologists believe that thoracic epidural anesthesia/analgesia (TEA) is contraindicated for cardiac surgery because of increased risk of paraplegia. However, this large prospective study confirms that perioperative morbidity is significantly less with TEA and suggests that the practical benefits may outweigh the unquantified risk of epidural hematoma.

PMID: 11524314, UI: 21415294

Anesth Analg 2001 Sep;93(3):526-7

Pain medicine and anesthesiologists: a new section of the journal.

Cousins MJ

[Medline record in process]

PMID: 11524313, UI: 21415293

Anesth Analg 2001 Sep;93(3):523-5

Epidural anesthesia and analgesia for coronary artery bypass graft surgery: still forbidden territory?

O'Connor CJ, Tuman KJ

Department of Anesthesiology, Rush Medical College, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois.

[Medline record in process]

PMID: 11524312, UI: 21415292