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

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*

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

PURPOSE: To investigate the prevalence of paralytic ileus after spinal operation in the supine or prone operative position and to determine the efficacy of prophylactic gastrointestinal motility medications in preventing symptomatic paralytic ileus after a spinal operation. MATERIALS AND METHODS: All patients received spinal surgery in the supine or prone operative position. The study period was divided into two phases: first, to analyze the prevalence of radiographic and symptomatic paralytic ileus after a spinal operation, and second, to determine the therapeutic effects of prophylactic gastrointestinal motility medications (postoperative intravenous injection of scopolamine butylbromide and metoclopramide hydrochloride) on symptomatic paralytic ileus after a spinal operation. RESULTS: Basic demographic data were not different. In the first phase of this study, 27 patients (32.9%) with radiographic paralytic ileus and 11 patients (13.4%) with symptomatic paralytic ileus were observed. Radiographic paralytic ileus was more often noted in patients who underwent an operation in the prone position (p=0.044); whereas the occurrence of symptomatic paralytic ileus was not different between the supine and prone positioned patients (p=0.385). In the second phase, prophylactic medications were shown to be ineffective in preventing symptomatic paralytic ileus after spinal surgery [symptomatic paralytic ileus was observed in 11.1% (4/36) with prophylactic medication and 16.7% (5/30) with a placebo, p=0.513]. CONCLUSION: Spinal surgery in the prone position was shown to increase the likelihood of radiographic paralytic ileus occurrence, but not symptomatic paralytic ileus. Unfortunately, the prophylactic medications to prevent symptomatic paralytic ileus after spine surgery were shown to be ineffective.
Adjuvants, Anesthesia/*administration & dosage/pharmacology ; Adult ; Aged ; Antiemetics/*administration & dosage/pharmacology ; Female ; Gastrointestinal Motility/*drug effects/physiology ; Humans ; Injections, Intravenous ; Intestinal Pseudo-Obstruction/drug therapy/epidemiology/*prevention & control ; Lumbar Vertebrae/radiography/*surgery ; Male ; Metoclopramide/*administration & dosage/pharmacology ; Middle Aged ; Postoperative Complications/epidemiology ; Prevalence ; Prone Position ; Prospective Studies ; Republic of Korea ; Scopolamine Hydrobromide/*administration & dosage/*pharmacology ; Spinal Fusion/*adverse effects ; Supine Position ; Treatment Outcome

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

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

Stimulation of the trigeminal nerve can elicit various cardiovascular and autonomic responses; however, the effects of anesthesia with pentobarbital sodium on these responses are unclear. Pentobarbital sodium was infused intravenously at a nominal rate and the lingual nerve was electrically stimulated at each infusion rate. Increases in systolic blood pressure (SBP) and heart rate (HR) were evoked by lingual nerve stimulation at an infusion rate between 5 and 7 mg·kg(-1)·h(-1). This response was associated with an increase in the low-frequency band of SBP variability (SBP-LF). As the infusion rate increased to 10 mg·kg(-1)·h(-1) or more, decreases in SBP and HR were observed. This response was associated with the reduction of SBP-LF. In conclusion, lingual nerve stimulation has both sympathomimetic and sympathoinhibitory effects, depending on the depth of pentobarbital anesthesia. The reaction pattern seems to be closely related to the autonomic balance produced by pentobarbital anesthesia.
Adjuvants, Anesthesia ; administration & dosage ; pharmacology ; Adrenergic alpha-Antagonists ; pharmacology ; Animals ; Autonomic Nervous System ; drug effects ; Cats ; Dose-Response Relationship, Drug ; Electric Stimulation ; Electrocardiography ; drug effects ; Hemodynamics ; drug effects ; Hexamethonium ; pharmacology ; Hypnotics and Sedatives ; administration & dosage ; pharmacology ; Infusions, Intravenous ; Lingual Nerve ; drug effects ; physiology ; Male ; Neural Inhibition ; Phentolamine ; pharmacology ; Trigeminal Nerve ; drug effects ; physiology

OBJECTIVETo investigate the effects of administration of dexmedetomidine in anaesthesia for esophageal cancer operation.

METHODS100 patients (ASAI-II) who were undergoing to esophageal cancer operation were randomly divided into control group (group A) and dexmedetomidine group (group B) (n = 50). The scheme of induction and maintenance of aesthesia of the two groups were identical. Patients in group B administered dexmedetomidine at a dose of 1 microg/kg over 10 min and patients in group A were given a placebo infusion of normal saline. Patients in group B administered dexmedetomidine at a dose of 0.4 microg/(kg x h) was injected and stoped at 30 min by the end of operation. Mean artery pressure (MAP) and heart rate (HR) were detected before induction (T0), induction (T1), 1 min after extubation (T2), 5 min after extubation (T3) and 10 min after extubation (T4) Propofol comsumption, fentanlyl comsumption, and side effects were recorded as well.

RESULTSThe results showed that MAP and HR (T0, T1, T2, T3, T4) in group B were significantly different from those in group A which fluctuated more markedly (P < 0.05). Propofol comsumption in group A was much more than that in group B (P < 0.05). Incidence of pharynx and larynx ache and restlessness were higher in group A than those in group B (P < 0.05).

CONCLUSIONDexmedetomidine could effectively reduce the cardiovascular response to incubation and extubation in esophageal cancer operation patients. Propofol comsumption, fentanlyl comsumption and side effects were reduceed as well.

Adjuvants, Anesthesia ; administration & dosage ; Adult ; Aged ; Analgesics, Non-Narcotic ; administration & dosage ; Anesthetics, Intravenous ; administration & dosage ; Dexmedetomidine ; administration & dosage ; Esophageal Neoplasms ; surgery ; Female ; Fentanyl ; administration & dosage ; Humans ; Male ; Middle Aged ; Propofol ; administration & dosage

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

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