BACKGROUND: This study is aimed to investigate the effect of tramadol on the bispectral index (BIS) during anesthesia with desflurane. METHODS: One hundred fifty adults, ASA class 1 and 2 patients, scheduled for general anesthesia for elective surgical procedures were included in this study. None of the patients were premedicated and anesthesia was induced with propofol 2 mg/kg and maintained with air-oxygen (FiO2 0.5) and desflurane, adjusted to keep the BIS between from 50 and 60. Forty minutes before completing surgery, the subjects were randomly allocated into 3 groups to receive saline (control group), tramadol 1.5 mg/kg (T1 group) or 3.0 mg/kg (T2 group) intravenously. Hemodynamics and BIS values were then recorded every 5 minutes until completion of the operation, during which time the concentrations of desflurane were not modified. RESULTS: The mean BIS values after tramadol administration weren't significantly different from the control group throughout the period of observation. No significant changes in the hemodynamics were noted, except systolic and diastolic arterial blood pressure in the T1 and T2 groups significantly increased in the first 5 minutes after the tramadol injection. CONCLUSIONS: The results indicate that the administration of tramadol while maintaining anesthesia with desflurane, adjusted to keep the BIS between 50 and 60, does not modified BIS values. So, we propose that tramadol can be safely administered as an immediate postoperative analgesia without concern about intra-operative awareness.
Adult ; Analgesia ; Anesthesia ; Anesthesia, General ; Arterial Pressure ; Hemodynamics ; Humans ; Isoflurane ; Propofol ; Surgical Procedures, Elective ; Tramadol

BACKGROUND: It has been reported that etomidate has the relaxant effects on vascular, tracheal, and non-pregnant uterine smooth muscle in vitro. The purpose of this study was to investigate the relaxant effects of etomidate on the contraction of the pregnant rat uterine smooth muscle. METHODS: Uterine muscle tissues were obtained from pregnant rats (n = 15). The uterine segments were mounted in organ baths filled with Krebs solution. After oxytocin-induced contractile activity had been established, etomidate in incremental concentrations (10(-7) to 10(-3) M) was added cumulatively to the bath, each administered 20 min apart, and resultant changes in contractile activity were continuously recorded. EC5 (effective concentration of 5% reduction), EC25, EC50, EC75, and EC95 on active tension were calculated using a probit model. RESULTS: Etomidate (10(-7) to 10(-3) M) induced dose-dependent decreases in amplitude and frequency of uterine contraction. The EC50 of etomidate on active tension were 5.91 x 10(-5) M. CONCLUSIONS: These results demonstrate that etomidate had inhibitory effects on pregnant rat uterine muscle at supraclinical concentration (5.91 x 10(-5) M).
Animals ; Baths ; Contracts ; Etomidate ; Female ; Isotonic Solutions ; Mice ; Muscle, Smooth ; Myometrium ; Oxytocin ; Rats ; Uterine Contraction

BACKGROUND: Intravenous injection of rocuronium produces intense discomfort at the site of injection in conscious patient. The purpose of this study was 2 folds; First, to determine the incidence of pain associated IV injection of rocuronium in adult patients. Second, to determine whether pretreatment with IV ondansetron affects the incidence of pain associated with the injection of rocuronium. METHODS: Eighty adult patients were randomly assigned to four groups. Before general anesthesia was induced with thiopental sodium (5 mg/ml), manual occlusion (70 mmHg) with tourniquet of venous inflow was performed. Randomly associated 20 patients received 4 ml of normal saline as a placebo control (Group 1). Other 60 patients allocated randomly to one of three groups: ondansetron 4 mg (Group 2), 6 mg (Group 3), 8 mg (Group 4) respectively. The patients' pain response to rocuronium injection was graded with using Memis' 4-point scale and withdrawal response was graded with using Kim's 4-point scale. RESULTS: Nineteen patients (95%) in the group 1, 18 patients (90%) in the group 2, 19 patients (95%) in the group 3, and 14 patients (85%) in the group 4 reported pain. Moderate to sever pain was 17 patients (85%), in the group 1, 11 patients (55%) in the group 2, 9 patients (45%) in the group 3, and 1 patient (5%) in the group 4. CONCLUSIONS: Ondansetron 4 mg, 6 mg, and 8 mg IV given before administration of rocuronium did not reduce incidence of pain on injection of rocuronium but significantly reduced severity of pain on injection of rocuronium and the 8 mg was more effective.
Adult* ; Anesthesia, General ; Humans ; Incidence ; Injections, Intravenous ; Ondansetron* ; Thiopental ; Tourniquets

BACKGROUND: Arthroscopic shoulder surgery is often associated with severe postoperative pain. It is important to control pain in this setting, not only to improve the patient's well-being but also to facilitate rehabilitation. The aim of this study was to investigate the efficacy of a continuous suprascapular nerve block for pain relief after arthroscopic shoulder surgery. METHODS: Forty patients (20 in each group) scheduled for elective arthroscopic shoulder surgery received a suprascapular nerve block and a catheter was introduced before surgery. The patients were received standardized general anesthesia. After surgery, a single bolus of normal saline (Group I) or 0.2% ropivacaine (Group II) 6 ml was injected through a catheter in each group. All patients received either a continuous infusion of normal saline (Group I) or a continuous infusion of 0.2% ropivacaine (Group II) through the catheter at a rate of 3 ml/hr plus a bolus of 3 ml with a lock out time of 30 min. Pain relief was assessed at 2, 4, 8, 12, 24 hours using visual analog scale (VAS) and verbal pain scores (VPS). RESULTS: VAS and VPS were lower in the ropivacaine group (Group II) than in the normal saline group (Group I). There were no complication in either group. CONCLUSIONS: Continuous suprascapular nerve block using 0.2% ropivacaine is a safe and efficacious treatment for postoperative shoulder pain.
Anesthesia, General ; Catheters ; Humans ; Nerve Block* ; Pain, Postoperative ; Rehabilitation ; Shoulder Pain ; Shoulder* ; Visual Analog Scale

BACKGROUND: Most surgical patients experience perioperative anxiety. This anxiety can effect the amount of preanesthetic medication and anesthetic agents needed, and contributes to postoperative pain. The effect of music on perioperative patient anxiety was studied. METHODS: Forty patients undergoing surgery with spinal anesthesia, were divided into two groups. Group I (n = 20) did not listen to music, and Group II (n = 20) listened to music selected by the patient. At ward, hemodynamic variables including systolic and diastolic blood pressures and pulse rates were measured as control values. Hemodynamic variables and the anxiety scores by the Hamilton anxiety rating scale and the Visual Analogue Scale (VAS) were prepared for Group I and Group II in the operating room. RESULTS: No difference was observed between the groups with regard to systolic blood pressure, diastolic blood pressure, mean arterial pressure, or pulse rate when patients arrived at the operating room. In Group II, 30 minutes after listening to music, anxiety scores, VAS, systolic blood pressures, and mean arterial pressures were significantly lower than in Group I. CONCLUSIONS: Music was found to effectively reduce intraoperative anxiety.
Anesthesia, Spinal* ; Anesthetics ; Anxiety* ; Arterial Pressure ; Blood Pressure ; Heart Rate ; Hemodynamics ; Humans ; Music* ; Operating Rooms ; Pain, Postoperative ; Preanesthetic Medication

BACKGROUND: Children usually exhibit pain-related behavior in the postanesthetic care unit. The aim of the present study was to compare the recovery and emergence profiles of children who received sevoflurane with caudal block or IV ketolorac or none for inguinal herniorrhaphy. METHODS: Forty five children, ASA 1, scheduled for herniorrhaphy were randomly assigned to receive either caudal block(n = 15), IV ketorolac (n = 15), or none (n = 15). All children were premedicated with midazolam(0.05 mg/kg) and glycopyrrolate (0.004 mg/kg) an hour before anesthesia induction. Thiopental sodium (5 mg/kg) and mask inhalation of sevoflurane 2 vol% in N2O/O2 50/50 were used to induce anesthesia. After induction, group 1 received none, while groups 2 and 3 received a caudal block and IV ketorolac, respectively. Anesthesia was maintained by sevoflurane with N2O/O2 inhalation via an endotracheal tube. Recovery was assessed by an independent observer using a postansthetic recovery score. Pain score was also assessed by an independent observer using a pain/discomfort scale. Recovery and agitation characteristics on emergence were compared between the three groups. RESULTS: There were no difference between the groups with respect to age, weight, duration of inhalation exposure, or recovery score. Agitation and pain scores were less in both the caudal block and IV ketorolac groups (P <0.05). Emergence delirium occurred less frequently in the caudal block and IV ketorolac groups (P <0.05). There was no significant difference between the caudal block and the IV ketorolac groups in emergence delirium. CONCLUSIONS: Emergence delirium after sevoflurane anesthesia was less common in the caudal block and IV ketorolac groups. Thus, it is presumed that the postoperative analgesic actions of caudal block or IV ketorolac reduce emergence delirium during recovery from sevoflurane anesthesia.
Anesthesia* ; Child* ; Delirium* ; Dihydroergotamine ; Glycopyrrolate ; Herniorrhaphy ; Humans ; Inhalation ; Inhalation Exposure ; Ketorolac* ; Masks ; Thiopental

Motor neuropathy of a lower extremity is well recognized potential complication of procedures performed on patients in a lithotomy position. Mechanisms of nerve injury are unclear but the incidence of perioperative nerve injuries can be reduced if anesthetists are aware of their causes and pathophysiolgies. It is important to note that reduced duration in lithotomy position may reduce the risk of lower extremity neuropathies. We experienced two case of common peroneal nerve palsy after lithotomy positioning. Diagnosis was based on history, a clinical examination and electrophysiologic studies. A neurologic examination revealed hypersthesia over the dorsum of the left foot with inability to perform active dorsiflexion. Electrophysiologic studies showed delayed latency and low amplitude of nerve action potential.
Action Potentials ; Diagnosis ; Foot ; Humans ; Incidence ; Lower Extremity ; Neurologic Examination ; Paralysis* ; Peroneal Nerve*

BACKGROUND: Epidural steroids have been suggested to prevent postoperative epidural fibrosis after lumbar laminectomy. The purpose of this prospective study was to compare the degree of postoperative pain in patients undergoing simple lumbar discectomy with and without epidural dexamethasone administration. METHODS: Thirty-six patients undergoing simple lumbar discectomy were randomly allocated to two groups to be given the following agents, just after the end of surgery via an epidural lumbar catheter previously inserted by the surgeon: normal saline 6 ml (group I), and a total of 6 ml normal saline with dexamethasone 5 mg (group II). The outcome measures included pain scores at 1, 2, 6, 12, and 24h and total morphine consumption over the first 24 postoperative hours. RESULTS: There were significant differences in the postoperative visual analogue scale (VAS) score at 1 and 2 h between the two Groups, and the 24h total morphine consumption in Group II was significantly lower than in Group I. CONCLUSIONS: Epidural administration of dexamethasone decreased the degree of postoperative pain after simple lumbar discectomy.
Catheters ; Dexamethasone* ; Diskectomy* ; Fibrosis ; Humans ; Laminectomy ; Morphine ; Outcome Assessment (Health Care) ; Pain, Postoperative ; Prospective Studies ; Steroids

BACKGROUND: Ropivacaine is an amino amide local anesthetic that has an advantage of a low-toxicity profile. Clonidine, an alpha2 adrenergic agonist, is known to prolong and intensify anesthesia from epidural local anesthetics. The aim of this study was to evaluate the dose-response effects of added clonidine to ropivacaine-fentanyl epidural anesthesia for lower extremity surgery. METHODS: Forty-five patients undergoing lower extremity surgery were randomly allocated to three groups to be given the following agents by an epidural route: 0.75% ropivacaine 15 ml+fentanyl 50microgram with clonidine 50microgram (group I), 100microgram (group II), or 150microgram (group III). Onset and maximal height of sensory block, and duration of sensory and motor block were assessed. Also, blood pressure, heart rate and sedation score were measured. RESULTS: Duration of sensory and motor block of groups II and III was significantly longer than that of group I, but there was no difference between group II and group III. Two segment regression times were significantly different among the three groups. Onset of sensory block, blood pressure, heart rate, and sedation scores were not significantly different among the three groups. CONCLUSIONS: The addition of Clonidine 100 and 150microgram prolonged duration of anesthesia more than 50microgram with ropivacaine-fentanyl epidural anesthesia for lower extremity surgery.
Adrenergic Agonists ; Anesthesia ; Anesthesia, Epidural* ; Anesthetics, Local ; Blood Pressure ; Clonidine* ; Heart Rate ; Humans ; Lower Extremity*

BACKGROUND: Epidural and intravenous administration of opioids had been commonly used for postoperative pain management in thoracoscopic surgery. Recently, interpleural analgesia was frequently used. The aim of this study was to compare the effect of an intravenous continuous infusion of fentanyl (F-IV) with interpleural bupivacaine (B-IP) using a continuous infusion system in the management of post-thoracoscopic pain. METHODS: An interpleural continuous infusion of bupivacaine (B-IP group: basal infusion 7(ng/kg/min) was compared with an intravenous continuous infusion of fentanyl (F-IV group: basal infusion 0.33ng/ kg/hr) in forty patients who had undergone elective thoracoscopic surgery. During the postoperative 48 hours, the visual analogue scale (VAS), Prince-Henry score (PHS), heart rate, respiratory rate and peripheral oxygen saturation were measured. RESULTS: The postoperative heart rate in both groups was significantly higher than the preoperative value (P < 0.05 1 h and 4 h after operation), but there were no differences in the respiratory rate and peripheral oxygen saturation between the two groups. There were significant improvement of the degree of pain in VAS and PHS after administration of the analgesic, but there was no significant differences in the two groups during 48 hours. The incidence of adverse effects such as nausea, vomiting, dizziness, urinary difficulty and respiratory depression was higher in the F-IV than the B-IP group. CONCLUSIONS: The interpleural continuous infusion of local anesthetics and intravenous continuous infusion of fentanyl provided effective analgesia in this study. The side effects were significantly lower in the interpleural continuous infusion of local anesthetics than intravenous continuous infusion of fentanyl. Therefore, interpleural continuous infusion of local anesthetics could be a useful alternative for postoperative analgesia after thoracoscopic surgery.
Administration, Intravenous ; Analgesia ; Analgesics, Opioid ; Anesthetics, Local ; Bupivacaine* ; Dizziness ; Fentanyl* ; Heart Rate ; Humans ; Hydrogen-Ion Concentration ; Incidence ; Interpleural Analgesia ; Nausea ; Oxygen ; Pain, Postoperative ; Respiratory Insufficiency ; Respiratory Rate ; Thoracoscopy* ; Vomiting