Backgound: The effect of dextromethorphan, an N-methyl d-aspartate (NMDA) antagonist, on the analgesic consumption and pain scoring after abdominal gynecologic surgery was studied. Methods: In this double-blind study, 60 patients were randomized into 2 groups. The study group was given oral dextromethorphan 25 mg 8 hours before the scheduled operation and one hour before the operation. Patients in the control group were given placebo capsules at the same intervals. Both groups of patients were given diclofenac sodium 75 mg i.m. prior to transfer to the post anesthesia care unit, and every twelve hours thereafter for a total of three doses. The study group was given dextromethorphan eight hours after the last dose prior to operation and every eight hours thereafter for the next 24 hours. The control group received placebo capsules at the same intervals. Visual analog pain scores were recorded preoperatively and at 4,8,12 and 24 hours postoperatively with the patient supine and coughing. Results: The mean VAS scores for the two groups, during rest and coughing, at 4 hours of observation, showed no significant difference. However, at 8 hours until 24 hours of observation, a significant difference was noted. Results of this study show that administration of dextromethorphan 25 mg orally preoperatively and postoperatively provides an adjuvant analgesic effect, as evidenced by lesser opioid requirements and lower resting and coughing VAS pain scores postoperatively. Conclusion: These results imply that the development of central hyperalgesia in the spinal cord induced by nociceptive stimulation of surgery was either blocked or modulated by dextromethorphan acting on NMDA receptors. The nonsedating property and lack of adverse side effects of dextromethorphan make it a promising alternative analgesic to other commonly used drugs.
Human ; Female ; Aged ; Middle Aged ; Adult ; HYPERALGESIA ; DEXTROMETHORPHAN ; GYNECOLOGIC SURGICAL PROCEDURES ; PAIN, POSTOPERATIVE

Background: Rapid confirmation of proper endotracheal placement is imperative in every patient subjected to tracheal intubation. Unrecognized esophageal intubation can lead to hypoxia, neurologic injury and cardiac arrest Objectives: The general objective of this study was to determine the accuracy of an improvised device, the DAD colorimetric end-tidal carbon dioxide monitor, for confirming tracheal intubation, using capnography as the gold standard in confirming tracheal intubation and detecting esophageal intubation. It also aimed to compare the mean number of breaths delivered by positive pressure ventilation using the anesthesia reservoir bag needed to confirm tracheal intubation and detect esophageal intubation by colorimetric method, chest auscultation and capnography Design: This is a prospective cohort and validity study Setting: Veterans Memorial Medical Center from June to August 2002. Methods: Upon intubation, endotracheal tube cuff was immediately inflated and connected to the DAD ETCO2 and breathing circuit. Endotracheal tube position was determined by three anesthesiologists who monitored chest auscultation, colorimetric ETCO2 and capnography. The number of breaths delivered by positive pressure ventilation was noted until tracheal intubation was confirmed Results: There were 52 tracheal intubations and 5 esophageal intubations. DAD ETCO2, capnography, and chest auscultation confirmed endotracheal tube position in all cases. DAD ETCO2 confirmed tracheal intubation earlier than capnography or chest auscultation (p0.0001). There was no significant difference between DAD ETCO2 and capnography detection times in detecting esophageal intubation. There were no false positive or false negative results with the use of the DAD ETCO2 Conclusion: The DAD colorimetric ETCO2 monitor is simple, accurate, and rapid in confirming tracheal intubation and detecting esophageal intubation. (Author)
Human ; Aged 80 and over ; Aged ; Middle Aged ; Adult ; Young Adult ; Adolescent ; INTUBATION, INTRATRACHEAL