RESUMEN
OBJECTIVE: To compare the analgesic effect of subcutaneous buprenorphine alone and in combination with propacetamol and ketoprofen following urologic surgery. STUDY DESIGN: Open randomized clinical trial. PATIENTS: Sixty ASA II/III patients undergoing urologic surgery. METHODS: The patients were randomized into three groups to receive either buprenorphine (0.3 mg subcutaneous) on demand (group 1, n = 20), or a combination of buprenorphine (0.3 mg)-propacetamol (2 g)-ketoprofen (100 mg) by intravenous route over 2 hours followed by an infusion of propacetamol (2 g) and ketoprofen (100 mg) at a constant rate over. The remaining 22 hours (group 2, n = 20), or the same loading dose as in group 2 prolonged by a continuous infusion of buprenorphine (0.3 mg), propacetamol (2 g) and ketoprofen (100 mg) over the same period (group 3, n = 20). Visual analogue scale pain scores (0-10) were assessed every hour during the 24 hours of the study. When the VAS score exceeded 5, an additional dose of 0.3 mg of buprenorphine was administered. RESULTS: Groups were similar for age, surgery, anaesthesia and initial pain levels. Compared to group 1, the onset of analgesia was earlier in groups 2 and 3 at the 1st hour (P < 0.05); the level of analgesia was lower at the 3rd hour (P < 0.05). The maintenance of this analgesia level required constant buprenorphine administration. Buprenorphine requirements were decreased to 56% and 37% in groups 2 and 3 respectively, compared to group 1 (P < 0.05). Incidence of nausea and vomiting was lowered to 15% in group 3 (P < 0.05). CONCLUSION: A combination of buprenorphine, propacetamol and ketoprofen provides effective postoperative analgesia with a low incidence of nausea and vomiting and decreased requirements of buprenorphine.
Asunto(s)
Acetaminofén/análogos & derivados , Analgésicos/uso terapéutico , Buprenorfina/uso terapéutico , Cetoprofeno/uso terapéutico , Dolor Postoperatorio/tratamiento farmacológico , Enfermedades Urológicas/cirugía , Acetaminofén/uso terapéutico , Adulto , Anciano , Anciano de 80 o más Años , Quimioterapia Combinada , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dimensión del DolorRESUMEN
Sufentanil is compared with fentanyl as a supplement to N2O isoflurane anaesthesia in a double blind study of 30 elderly patients undergoing major urological surgery. Comparison is made with respect to 1) haemodynamic (heart rate, blood pressure) responses during surgery and recovery; 2) time to extubation after the end of surgery; 3) Postoperative analgesia. No difference is observed between the two groups with respect to demographic data, duration of surgery, and total doses of muscle relaxants. Total doses of opioids used are 195 micrograms of sufentanil and 1,215 micrograms of fentanyl. Arterial pressure and heart rate are different during intubation and major events of surgery. Times between end of surgery and extubation are different: 77 +/- 13 min the sufentanil group versus 57 +/- 22 min the fentanyl group (p < 0.05). Use of analgesia is significantly delayed in the sufentanil group. It is suggested that sufentanil, in elderly patients, provides a better haemodynamic stability and a greater residual analgesia than fentanyl in the immediate postoperative period.
Asunto(s)
Anestesia Intravenosa/métodos , Fentanilo , Sufentanilo , Enfermedades Urológicas/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Anestésicos/administración & dosificación , Método Doble Ciego , Femenino , Hemodinámica/efectos de los fármacos , Humanos , Masculino , Persona de Mediana Edad , Dolor Postoperatorio , Estudios ProspectivosRESUMEN
We describe two cases of altered consciousness associated with nausea and vomiting after renal surgery. These events occurred respectively one and two hours after surgery. They are believed to be caused by the transfer of large amounts of irrigating solution containing glycine 1.5%. The effects of hyponatraemia (132 and 129 mmol.L-1) and glycinaemia (3518 and 8589 mmol.L-1) are discussed. We conclude on the importance of an early clinical diagnosis completed by biological investigation to allow an adequate symptomatic management.
Asunto(s)
Glicina/envenenamiento , Riñón/cirugía , Anciano , Quistes/cirugía , Femenino , Glicina/administración & dosificación , Glicina/sangre , Humanos , Hiponatremia/etiología , Enfermedades Renales/cirugía , Masculino , Persona de Mediana Edad , Irrigación Terapéutica/efectos adversos , Cálculos Ureterales/cirugíaRESUMEN
The efficacy of sublingual buprenorphine given for premedication was assessed in 287 consecutive patients scheduled for extracorporeal shock wave lithotripsy (ESWL). The patients were randomly assigned to three groups. They were given 45 min before starting ESWL 5 mg midazolam orally in group 1 (n = 97), and 5 mg midazolam orally and 0.2 mg sublingual buprenorphine in group 2 (n = 97), and 5 mg midazolam orally and 0.4 mg sublingual buprenorphine in group 3 (n = 93). Analgesia was assessed with a simple three step verbal scale: no pain, moderate pain treated with simple analgesics (Spasfon, Viscéralgine), and exquisite pain requiring general anaesthesia. Sublingual buprenorphine provided good analgesia in 87% of group 2 patients, and 88% of group 3 patients (NS) whereas 70% of group 1 patients experienced no pain (p < 0.05). The incidence of side-effects during the 12 h following ESWL, such as nausea, vomiting and drowsiness, was higher in group 3 (31 patients) than in group 2 (13 patients) (p > 0.01). No clinical respiratory depression occurred, although 11 patients in group 3 complained of drowsiness. It is concluded that premedication with 0.2 mg of sublingual buprenorphine provides efficient analgesia for ESWL and few side-effects.
Asunto(s)
Analgesia/métodos , Buprenorfina/administración & dosificación , Cálculos Renales/terapia , Litotricia , Administración Sublingual , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Combinación de Medicamentos , Femenino , Humanos , Masculino , Midazolam/administración & dosificación , Persona de Mediana Edad , Dimensión del Dolor , Medicación Preanestésica/métodosRESUMEN
Two cases of coma occurring during transurethral resection of the prostate are reported. The 76 and 85-year-old patients lapsed into coma, ranking 9 and 8 on the Glasgow scale, respectively 90 and 120 min after the start of the resection, without any previous haemodynamic alterations. In one patient, coma occurred when the urethral catheter became blocked with fragments of prostates. In the other, coma was initiated by a rupture of the prostatic capsule, with passage of washing fluid (1.5% glycine solution) into the peritoneal cavity. The role played by acute hyponatraemia (128 and 123 mmol.l-1 respectively) and glycine poisoning (10,188 and 11,840 mmol.l-1 respectively) are discussed. These cases underline the interest of regional anaesthetic techniques, allowing an early diagnosis and a rapid surgical procedure which will avoid a worsening of the condition.
Asunto(s)
Coma/etiología , Glicina/efectos adversos , Hiponatremia/etiología , Prostatectomía/efectos adversos , Administración Intravesical , Anciano , Anciano de 80 o más Años , Anestesia de Conducción , Coma/fisiopatología , Glicina/administración & dosificación , Glicina/sangre , Humanos , Hiponatremia/fisiopatología , MasculinoRESUMEN
The aim of this study is to compare the efficiency of Cefamandole and Ceftriaxone in short-term antibioprophylaxis after transurethral prostatectomy. Ceftriaxone reduces significatively postoperative febrile reactions, although no difference is seen between the 2 regimens: 27% in group Cefamandole versus 18% in group Ceftriaxone. Postoperative urinary tract infections do not depend neither on time resection nor on weight of resected tissues. Bladder catheter removal should be treated by short-term antibiotics in order to further reduce postoperative infections.
Asunto(s)
Cefamandol/uso terapéutico , Ceftriaxona/uso terapéutico , Prostatectomía , Infección de la Herida Quirúrgica/prevención & control , Anciano , Anciano de 80 o más Años , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The effects of acute isovolaemic haemodilution (AIH) on propofol pharmacokinetics were studied in 16 male patients scheduled for prostatectomy. They were all ranked ASA 1, and were randomly allocated to two groups, group I (n = 8), who did not undergo any haemodilution, and group II (n = 8), in whom AIH was carried out. Anaesthesia was induced with a single 2.5 mg.kg-1 propofol bolus given in 30 s; maintenance was achieved with fentanyl 2 micrograms.kg-1, atracurium 1 mg.kg-1, and a ventilation with a mixture of nitrous oxide in oxygen 50 %, with enflurane 1 %. Those patients due to be haemodiluted had blood withdrawn before surgery (1,387.5 +/- 423.3 ml), at the same time as they were given the same volume of modified fluid gelatin (Plasmion). The volume of blood to be withdrawn was calculated according to the initial haematocrit, and that required. Haematocrit was decreased to 32.3 +/- 3.9 % (extremes 27 and 37 %). Thereafter blood samples were then collected over a 24 h period, which included surgery. Propofol was assayed in whole blood using high performance liquid chromatography. Analysis with a three-compartment model was carried out. The AIH only altered the central compartment volume (65.5 +/- 15.6 l in the control group vs 83.6 +/- 13.3 l in group II, p less than 0.01). Initial concentrations were not significantly different in the two groups (2,892 +/- 762 ng.ml-1 in controls vs 2,373 +/- 589 ng.ml-1 in the others). Clinically, anaesthesia and recovery were uneventful. It is concluded that the induction dose of propofol in patients scheduled for haemodilution does not require any alteration.