BACKGROUND: Postoperative nausea and vomiting (PONV) is the major complication related to general anesthesia, occurring in 60–80% of patients after thyroidectomy. The objective of this study was to compare the effects of an intraoperative dexmedetomidine infusion with remifentanil, as anesthetic adjuvants of balanced anesthesia, on PONV in patients undergoing thyroidectomy. METHODS: Eighty patients scheduled for thyroidectomy were randomized into the following two groups: 1) The dexmedetomidine group (Group D), who received an initial loading dose of dexmedetomidine (1 µg/kg over 10 min) during the induction of anesthesia, followed by a continuous infusion at a rate of 0.3–0.5 µg/kg/h; 2) the remifentanil group (group R), who received remifentanil at an initial target effect site concentration of 4 ng/ml during the induction of anesthesia, followed by a target effect site concentration of 2–3 ng/ml. PONV was assessed during the first 24 hours in 2 time periods (0–2 h and 2–24 h). The pain intensity, sedation score, extubation time, and hemodynamics were also assessed. RESULTS: During the 2 time periods, the incidence and severity of PONV in group D were significantly lower than in group R. In addition, the need for rescue antiemetics was significantly lower in group D than in group R. The effect of dexmedetomidine on postoperative pain relief (2–24 h) was superior to that of remifentanil. The hemodynamics were similar in both groups, whereas eye opening and extubation time were delayed in group D. CONCLUSIONS: Adjuvant use of intraoperative dexmedetomidine infusion may be effective for the prevention of PONV.
Adjuvants, Anesthesia ; Anesthesia ; Anesthesia, General ; Antiemetics ; Balanced Anesthesia* ; Dexmedetomidine* ; Hemodynamics ; Humans ; Incidence ; Pain, Postoperative ; Postoperative Nausea and Vomiting* ; Thyroidectomy*

Although the incidence of extrapyramidal reactions associated with metoclopramide has been reported to be approximately 0.2%, such reactions are rare in the anesthetic field. Several anesthetic adjuvants, including ondansetron and pregabalin, have also been associated with extrapyramidal side effect. Here, the authors report the case of a 47-year-old patient, previously administered pregabalin and ondansetron, who developed extrapyramidal side effects after a single injection of metoclopramide (10 mg) in a post-anesthesia care unit.
Adjuvants, Anesthesia ; gamma-Aminobutyric Acid ; Humans ; Incidence ; Metoclopramide ; Middle Aged ; Ondansetron ; Pregabalin

BACKGROUND: The purpose of this study was to evaluate the effect of dexamethasone or dexmedetomidine added to ropivacaine on the onset and duration of ultrasound-guided axillary brachial plexus blocks (BPB). METHODS: Fifty-one ASA physical status I-II patients with elective forearm and hand surgery under axillary brachial plexus blocks were randomly allocated to receive 20 ml of 0.5% ropivacaine with 2 ml of isotonic saline (C group, n = 17), 20 ml of 0.5% ropivacaine with 2 ml (10 mg) of dexamethasone (D group, n = 17) or 20 ml of 0.5% ropivacaine with 2 ml (100 microg) of dexmedetomidine (DM group, n = 17). A nerve stimulation technique with ultrasound was used in all patients. The onset time and duration of sensory blocks were assessed. RESULTS: The duration of the sensory block was extended in group D and group DX compared with group C (P < 0.05), but there was no significant difference between group D and group DX. However, there were no significant differences in onset time in all three groups. CONCLUSIONS: Dexamethasone 10 mg and dexmedetomidine 100 microg were equally effective in extending the duration of ropivacaine in ultrasound-guided axillary BPB with nerve stimulation. However, neither drug has significantly effects the onset time.
Adjuvants, Anesthesia* ; Analgesia ; Brachial Plexus* ; Dexamethasone* ; Dexmedetomidine* ; Forearm ; Hand ; Humans ; Ultrasonography

OBJECTIVE: To evaluate the accuracy of cerebral state index (CSI) as an indicator of anesthesia depth in patients in the induction of anesthesia with target-controlled infusion of propofol. METHODS: Forty ASA (American Society of Anesthesiologists) I approximately II patients scheduled for an operation under general anesthesia were anesthetized with target-controlled infusion of propofol. Target plasma concentration was 0. 5 mg/L at the beginning, and increased by 0. 5 mg/L every 5 minutes, till 5 minutes after the level of MOAA/S (modified observer's assessment of alertness/sedation) was 0. The CSI, mean arterial pressure (MAP), heart rate (HR), MOAA/S level, and the effect-site concentration of propofol were recorded. RESULTS: (1) CSI values declined with the decrease of MOAA/S levels. CSI values were statistically different between level 0 and 1, level 1 and 2, level 3 and 4, level 4 and 5 of MOAA/S (P < 0.05). The difference of MAP had statistical significance between level 3 and level 2 of MOAA/S (P < 0.05). HR values had no statistical difference between the two levels of MOAA/S (P > 0.05). (2) The spearman rank correlation co-efficients between CSI, MAP, HR and the level of MOAA/S were 0.929, 0.421, and 0.085, respectively. The prediction probabilities (Pk) to differentiate different levels of MOAA/S for CSI, MAP, and HR were 0.94, 0.67, and 0.54, respectively. (3) There was linear regression relationship between CSI and the effect-site concentration of propofol (the coefficient of determination R2 was 0. 833, P < 0.01). CONCLUSION During the induction of patients with target-controlled infusion of propofol, the CSI is accurate as an indicator of awakeness and different levels of consciousness after anesthesia, and can reliably predict the anesthesia depth.
Adjuvants, Anesthesia ; Adult ; Anesthesia, General ; Anesthetics, Intravenous ; Cerebral Cortex ; drug effects ; physiology ; Female ; Humans ; Male ; Monitoring, Intraoperative ; methods ; Propofol

BACKGROUND: This prospective, randomized, double blinded, controlled study was designed to compare effects of intravenous co-administration of clonidine, magnesium, or ketamine on anesthetic consumption, intraoperative hemodynamics, postoperative analgesia and recovery indices during Bispectral Index (BIS) guided total intravenous anesthesia (TIVA). METHODS: After ethical committee approval and written informed consent, 120 adult patients ASA I and II scheduled for open cholecystectomy were randomly assigned to one of 4 equal groups. Group CL received clonidine 3 microg/kg and maintained by 2 microg/kg/h. Group MG received magnesium sulphate 50 mg/kg and maintained by 8 mg/kg/h. Group KET received racemic ketamine 0.4 mg/kg and maintained by 0.2 mg/kg/h. Control group (CT) received the same volume of isotonic saline. Anesthesia was induced and maintained by fentanyl, propofol and rocuronium. Propofol infusion was adjusted to keep the BIS value between 45-55. Intraoperative hemodynamics, induction time, anesthetic consumption, recovery indices, and PACU discharge were recorded. RESULTS: Induction time, propofol requirements for induction and maintenance of anesthesia, intraoperative fentanyl and hemodynamic values were significantly lower with Groups CL and MG compared to Groups KET and CT (P < 0.05). Patients in Group MG showed significantly lower muscle relaxant consumption, delayed recovery and PACU discharge than other groups (P < 0.05). First, analgesic requirement was significantly longer and total postoperative analgesic consumption was significantly lower in the adjuvant groups versus Group CT (P < 0.05). CONCLUSIONS: Clonidine, magnesium, and ketamine can be useful adjuvant agents to BIS-guided TIVA. Pharmacokinetic studies of such drug combinations were recommended to investigate their interaction.
Adjuvants, Anesthesia ; Adult ; Analgesia ; Androstanols ; Anesthesia ; Anesthesia, Intravenous ; Cholecystectomy ; Clonidine ; Drug Combinations ; Fentanyl ; Hemodynamics ; Humans ; Informed Consent ; Ketamine ; Magnesium ; Muscles ; Propofol ; Prospective Studies

Herpes zoster is a relapse of varicella. In certain cases, long-term pain and hyperhidrosis have been noted. Appearance of herpes zoster during pregnancy is infrequent. We described hyperhidrosis and pain treatment using glycopirrolate cream in a pregnant woman with herpetic neuralgia. A 32 year old woman, 21 weeks pregnant with second child, complained to her gynecologist of the appearance of a vesicular rash on the left half of the forehead that progressed toward her left eyelid, accompanied by lancinating pain, allodynia, hyperhidrosis and small edema, blepharitis and conjunctivitis. Following clinical and laboratory tests, she was diagnosed with herpes zoster ophtalmicus. Aciclovir therapy was administered 800 mg orally five times daily for seven days. Pain therapy was initiated with amitriptilline. We discontinued amitriptilline therapy after 10 days because of appearance of unwanted side effects. After skin changes ceased, we introduced Lidocaine patch into pain therapy which reduced the allodynia, but not the lancinating pain and hyperhidrosis. At that time we began using glycopirrolate cream which reduced pain intensity by 28.5% within 24 hours, and completely eliminated hyperhidrosis. After 48 hours of use, the pain completely disappeared. During the Glycopirrolate cream therapy, there were no side effects. This is a first report to document that a topical Glycopirrolate cream has a beneficial effect in a patient with hyperhidrosis and herpetic neuralgia.
Adjuvants, Anesthesia/administration & dosage/*therapeutic use ; Administration, Topical ; Adult ; Female ; Glycopyrrolate/administration & dosage/*therapeutic use ; Herpes Zoster/*drug therapy/pathology ; Humans ; Neuralgia/pathology/*physiopathology ; Pregnancy

OBJECTIVETo prove analgesia and sedative effect of adjuvant anesthesia with magnetic auricular point-sticking on abdominal gynecological operation and its effect on postoperative recovery of body function.

METHODSNinety-two patients with abdominal gynecological operation were randomly divided into 3 groups. The auricular point-sticking group (APS group, n=31) was pasted and pressed by plasters with magnetic beads at bilateral Shenmen, Pizhixia (subcortex), Zigong (uterus) and Penqiang (pelvic cavity), etc. the night before operation. The placebo group (n=31) was pasted by plasters without magnetic beads. The blank group (n=30) was given no intervention. The mental and gastrointestinal functional changes before and 3 days after the operation were observed.

RESULTSAs compared with those in the control group and the blank group, the postoperative score of Self rating Anxiety Scale (SAS) was less (25.5 +/- 0.81 vs. 28.9 +/- 3.19, 28.3 +/- 2.36, both P < 0.01), with lower-dose of Innovar [(2.5 + 1.1) mL vs. (3.4 + 1.8) mL, (3.2 + 1.6) mL, both P < 0.05], earlier exsufflation after the operation [(34.2 + 12.1) h vs. (46.3 + 10.9) h, (43.2 + 14.8) h, both P < 0.01] and higher level serum of beta-endorphin before and after the operation in the APS group (all P < 0.05).

CONCLUSIONThe magnetic auricular point-sticking has sedative, analgesic and function-regulating effects on the abdominal gynecological operation.

Acupuncture Analgesia ; Acupuncture, Ear ; Adjuvants, Anesthesia ; administration & dosage ; Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Pain, Postoperative ; drug therapy ; physiopathology ; therapy ; Postoperative Period ; Recovery of Function ; Young Adult

OBJECTIVETo assess the feasibility of using subclinical doses of pentazocine in painless egg retrieval.

METHODSEighty-one patients undergoing painless egg retrieval were randomized into the observation group and the control group to receive 0.4 mg/kg pentazocine with 1.5 mg/kg propofol and 0.5 mg/kg pentazocine with 1.5 mg/kg propofol, respectively. The mean arterial pressure (MAP), heart rate (HR), SPO(2), respiratory rate (RR), unconsciousness time, awake time, hospital stay, complications, consciousness during the operation and adverse effects were compared between the two groups.

RESULTSThe two groups showed no significant differences in the analgesic effect, dosage of propofol, adverse effects, unconsciousness time, awake time, or hospital stay. But compared with the control group, the observation group showed greater intraoperative consciousness but with more stable respiration.

CONCLUSIONSubclinical doses of pentazocine can be used in the painless egg retrieval, but the dose of propofol should be increased to reduce the body activity during the operation.

Adjuvants, Anesthesia ; administration & dosage ; Adult ; Anesthetics, Intravenous ; Female ; Fertilization in Vitro ; Humans ; Intraoperative Complications ; prevention & control ; Oocyte Donation ; methods ; Pain ; prevention & control ; Pentazocine ; administration & dosage ; Propofol ; administration & dosage ; Vagina

BACKGROUND: Magnesium is one of the effective, safe local anesthetic adjuvants that can exert an analgesic effect in conditions presenting acute and chronic post-sternotomy pain. We studied the efficacy of continuous infusion of presternal magnesium sulfate with bupivacaine for pain relief following cardiac surgery. METHODS: Ninety adult patients undergoing valve replacement cardiac surgery randomly allocated into three groups. In all patients; a presternal catheter was placed for continuous infusion of either 0.125% bupivacaine and 5% magnesium sulfate (3 ml/h for 48 hours) in group 1, or 0.125% bupivacaine only in the same rate in group 2, versus conventional intravenous paracetamol and ketorolac in group 3. Rescue analgesia was iv 25 µg fentanyl. Postoperative Visual Analog Scale (VAS) and fentanyl consumption during the early two postoperative days were assessed. All patients were followed up over two months for occurrence of chronic post-sternotomy pain. RESULTS: VAS values showed high significant differences during the first 48 hours with the least pain scale in group 1 and significantly least fentanyl consumption (30.8 ± 7 µg in group 1 vs. 69 ± 18 µg in group 2, and 162 ± 3 in group 3 respectively). The incidence of chronic pain has not differed between the three groups although it was more pronounced in group 3. CONCLUSIONS: Continuous presternal bupivacaine and magnesium infusion resulted in better postoperative analgesia than both presternal bupivacaine alone or conventional analgesic groups.
Acetaminophen ; Adjuvants, Anesthesia ; Adult ; Analgesia ; Bupivacaine ; Catheters ; Chronic Pain ; Double-Blind Method ; Fentanyl ; Humans ; Incidence ; Ketorolac ; Magnesium Sulfate ; Magnesium ; Thoracic Surgery ; Visual Analog Scale

In acupuncture practice of animals, preanesthetics sometimes are needed. The purpose of this study was to select the ideal chemical restraint at acupuncture for gastric motility. Nine healthy mixed breed dogs weighed 10-21 kg and aged 1-3 years old were used in this study. Two EMG surface electrodes were placed between the seromuscular and the mucosal layer of pylorus. Twenty minutes after feeding normal gastric motility was recorded for 60 minutes using physiograph (Narco-Biosystem). Then preanesthetic treated-gastric motility was observed for 30 minutes. Preanesthetics used were xylazine, diazepam, and acepromazine. Acupuncture needles were inserted to BL-21 (Wei-Yu) acupoint, and then changes of gastric motility were recorded for 60 minutes. The gastric motility following xylazine administration (1 mg/kg, IV) was markedly decreased. BL-21 (Wei-Yu) acupoints stimulation did not alter xylazine-induced depression of gastric motility. The diazepam (1 mg/kg IV) treated-gastric motility was increased mildly 20 minutes after drug administration. BL-21 (Wei-Yu) acupoint stimulation after diazepam administration enhanced gastric motility significantly. The gastric motility following acepromazine (0.3 mg/kg, IM) administration was not changed compared with normal gastric motility. Application of traditional acupuncture at BL-21 (Wei-Yu) significantly increased the gastric motility. Based on these results, acepromazine and diazepam could be acceptable chemical restraints for acupuncture therapy of gastric motility, but xylazine couldn't be.
Acepromazine ; Acupuncture/*standards ; *Acupuncture Points ; Adjuvants, Anesthesia ; Adrenergic alpha-Agonists ; Animals ; Antipsychotic Agents ; Atropine ; Diazepam ; Dogs/*physiology ; Dopamine Antagonists ; Electromyography/veterinary ; Gastrointestinal Motility/drug effects/*physiology ; Hypnotics and Sedatives ; Metoclopramide ; Parasympatholytics ; Preanesthetic Medication/standards/*veterinary ; Xylazine