Abstract:
STUDY OBJECTIVES:To examine the effect of timing of an intravenous (i.v.) dose (intraoperative vs. postoperative) of ketorolac tromethamine on pain scores and overall outcome after total abdominal hysterectomy (TAH) and myomectomy. DESIGN:Prospective, randomized, placebo-controlled study. PATIENTS:248 ASA physical status I and II adult female patients scheduled for elective hysterectomy or myomectomy. INTERVENTIONS:General anesthesia was administered that consisted of thiopental sodium for induction, enflurane or isoflurane in nitrous oxide-oxygen for maintenance, and small doses of fentanyl and midazolam. Patients were randomized into three groups to receive toradol/placebo on a dosing schedule of dose 1 given one-half hour prior to expected end of surgery, dose 2 given on awakening in the postanesthesia care unit, and doses 3, 4, and 5 given at 6, 12, and 18 hours, respectively, after dose 2; Group 1 patients received placebo (saline) for dose 1, ketorolac 60 mg i.v. for dose 2, and ketorolac 30 mg i.v. for doses 3, 4, and 5. Group 2 patients received ketorolac 60 mg i.v. for dose 1, placebo for dose 2, and ketorolac 30 mg i.v. for doses 3, 4, and 5. Group 3 patients received placebo for all doses. All patients were given i.v. morphine PCA postoperatively, and morphine usages, visual analog pain intensity (VAS) scores, as well as adverse events and median times to recovery milestones were recorded. MEASUREMENTS AND MAIN RESULTS:VAS scores (mean) before dose 2 were significantly lower in Group 2 than Group 1, as were at-rest evaluations at 15 minutes and one hour. Group 2 patients also had decreased morphine requirements as compared to placebo. Both ketorolac groups (Groups 1 and 2) had significantly higher values for patient and observer overall ratings, case of nursing care, and tolerability as compared to placebo (Group 3). There were no significant differences among groups in adverse events or median times to recovery milestones. CONCLUSIONS:Although it is possible to demonstrate an improvement in early postoperative pain scores with intraoperative ketorolac and better overall ratings of ketorolac both intraoperatively and postoperatively as compared with placebo, the lack of clinically significant differences in analgesic efficacy in the two active study groups indicates the need for a careful consideration by the clinician of the risks versus benefits involved in the administration of antiplatelet medication in the perioperative period.
journal_name
J Clin Anesthjournal_title
Journal of clinical anesthesiaauthors
Balestrieri P,Simmons G,Hill D,Brown J,Jackson A,Brull SJ,Maneatis TJ,Shefrin A,Bynum L,O'Hara DAdoi
10.1016/s0952-8180(97)00062-7subject
Has Abstractpub_date
1997-08-01 00:00:00pages
358-64issue
5eissn
0952-8180issn
1873-4529pii
S0952818097000627journal_volume
9pub_type
临床试验,杂志文章,多中心研究,随机对照试验abstract::Hereditary angioedema with normal C1-esterase inhibitor (HAE-nC1INH) perioperative is a rare condition which could have potential disastrous ramifications for the anesthesiologist in the perioperative period. However, there is limited evidence and/or guidelines on the optimal way to manage these patients. We present t...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2016.08.042
更新日期:2016-12-01 00:00:00
abstract::Insertion of drug-eluting stents is one of the strategies for treating patients with coronary artery disease. These patients can be a perioperative challenge in management as they need to be maintained on antiplatelet therapy to prevent stent thrombosis, which puts them at an increased risk for surgical bleeding. Rece...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2008.11.013
更新日期:2009-11-01 00:00:00
abstract:BACKGROUND:Operative hysteroscopy is accompanied by the use of distention medium. Its absorption can lead to volume overload and hemodynamic disturbances that can lead to serious complications. We investigated the impact of the type of anesthesia on decreasing these complications with the use of noninvasive thoracic bi...
journal_title:Journal of clinical anesthesia
pub_type: 临床试验,杂志文章
doi:10.1016/j.jclinane.2016.06.023
更新日期:2017-05-01 00:00:00
abstract:OBJECTIVES:To determine if the infraclavicular brachial plexus block can be applied with lower volume of local anesthetic. DESIGN:Randomised, double-blinded clinical trial. PATIENTS:60 patients aged 5-15years with ASA I-II who underwent emergent or elective arm, forearm or hand operations were included in the study. ...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jclinane.2016.12.017
更新日期:2017-09-01 00:00:00
abstract:STUDY OBJECTIVE:We evaluated the efficacy of a multidisciplinary approach to reduce postoperative complications and 1-year mortality in patients, undergoing hip fracture surgery and the impact of surgical delay on mortality. DESIGN:A non-randomized intervention study with a historical control group (CG). SETTING:Duri...
journal_title:Journal of clinical anesthesia
pub_type: 临床试验,杂志文章
doi:10.1016/j.jclinane.2018.09.029
更新日期:2019-03-01 00:00:00
abstract:INTRODUCTION:There is currently no consensus regarding the minimum threshold platelet count to ensure safe neuraxial procedures. Numerous reports describe the safe performance of lumbar punctures in severely thrombocytopenic patients but reports of neuraxial anesthetic procedures in thrombocytopenic patients are limite...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2019.109666
更新日期:2020-05-01 00:00:00
abstract:STUDY OBJECTIVE:To evaluate the accuracy and precision of estimation of partial pressure of carbon dioxide (Pa(CO2)) using end-tidal or transcutaneous CO2 (TcP(CO2)) measurements during mechanical ventilation in the elderly patient. DESIGN:A prospective, observational study was conducted. SETTINGS:The study was done ...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2006.02.007
更新日期:2006-09-01 00:00:00
abstract::The case of a patient with hereditary angioedema (HAE), a rare, life-threatening disorder caused by reduced activity of the C1 esterase inhibitor, and requiring off-pump coronary artery bypass graft (OP-CABG) surgery, is presented. Perioperative management of patients with HAE who undergo complex cardiac surgical proc...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2009.04.007
更新日期:2010-06-01 00:00:00
abstract:STUDY OBJECTIVE:To test the hypothesis that midazolam potentiates thiopental sodium-induced unconsciousness. DESIGN:Randomized, double-blind study. SETTING:A university medical center. PATIENTS:Fifty nonpremedicated ASA physical status I and II adult patients scheduled for eye surgery. INTERVENTIONS:Intravenous (IV...
journal_title:Journal of clinical anesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/0952-8180(91)90177-o
更新日期:1991-09-01 00:00:00
abstract::Alzheimer's disease is a form of dementia that is estimated to affect approximately 3 to 4 million Americans. Given the substantial number of people affected with this disease, it is likely that anesthesiologists will encounter many patients with Alzheimer's disease. Questions as to potential problems including inform...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章,评审
doi:10.1016/s0952-8180(02)00483-x
更新日期:2003-02-01 00:00:00
abstract::A case of persistent thoracic cerebrospinal fluid cutaneous fistula in a toddler following radiographically confirmed epidural catheter placement is reported. Treatment of the fistula with a thoracic epidural blood patch was successful. ...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2012.11.012
更新日期:2013-06-01 00:00:00
abstract:STUDY OBJECTIVE:To develop categories of behavior that define an applicant's aptitude for anesthesia, and to attempt to determine the relative importance of these behaviors to successful residency performance. DESIGN:Prospective open study. SETTING:Anesthesia residencies at three midwest university teaching hospitals...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/s0952-8180(97)00195-5
更新日期:1997-12-01 00:00:00
abstract::Kearns-Sayre syndrome (KSS) is a rare mitochondrial myopathy and often involves cardiac conduction abnormality and muscle weakness. We report a patient with KSS who had an implantable cardioverter-defibrillator (ICD) implanted during general anesthesia with propofol and nitrous oxide (N2O). These anesthetics did not s...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2004.08.002
更新日期:2004-11-01 00:00:00
abstract::Hemodynamic instability as a result of altered baroreflex mechanism is common in surgeries involving manipulation around the carotid sheath. We report a case in which hypertensive crisis was associated with laryngectomy during general anesthesia. Perioperative use of vasoactive agents such as alpha(2) agonists may hel...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2006.12.011
更新日期:2007-11-01 00:00:00
abstract:STUDY OBJECTIVE:To determine the value of clinical history and preoperative coagulation tests. DESIGN:Prospective, multicenter clinical investigation. SETTING:Twenty-four centers over a one-year period. PATIENTS:1,706 children scheduled for tonsillectomy. In 1, 479 out of 1,706 children, studied age was ranged from ...
journal_title:Journal of clinical anesthesia
pub_type: 临床试验,杂志文章,多中心研究
doi:10.1016/s0952-8180(00)00164-1
更新日期:2000-06-01 00:00:00
abstract::During transplant surgery, clot formation resulting in life-threatening thromboembolic phenomena or graft loss may be a consequence unless close monitoring of coagulation and anticoagulation treatment is instituted in a timely manner. Three cases with a hypercoagulable state, as determined by thrombelastography at the...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2009.10.021
更新日期:2011-02-01 00:00:00
abstract:STUDY OBJECTIVE:To provide a contemporary medicolegal analysis of claims brought against anesthesia providers in the United States related to neuraxial blocks for surgery and obstetrics. DESIGN:In this retrospective analysis, we analyzed closed claims data from the Controlled Risk Insurance Company (CRICO) Comparative...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2019.03.013
更新日期:2019-11-01 00:00:00
abstract:STUDY OBJECTIVE:To ascertain the optimal dose of trimethaphan camsylate administered by intravenous (i.v.) bolus injection for the control of hypertension and tachycardia during electroconvulsive therapy (ECT). DESIGN:Prospective, double blind, within-subject study. SETTING:Treating room of the psychiatric unit of th...
journal_title:Journal of clinical anesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/0952-8180(95)00192-1
更新日期:1996-03-01 00:00:00
abstract::Although digoxin remains one of the most widely prescribed drugs in the United States, potential pharmacodynamic and pharmacokinetic interactions between this compound and other drugs, diseases, and events commonly encountered in the perioperative period remain largely unappreciated. Furthermore, the therapeutic benef...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章,评审
doi:10.1016/0952-8180(92)90170-6
更新日期:1992-09-01 00:00:00
abstract:STUDY OBJECTIVE:To assess the impact of intraoperative hemodynamics in the development of perioperative myocardial infarction (MI) and myocardial ischemia after noncardiac surgery. DESIGN:Single-center retrospective cohort study of surgical patients from 2007 to 2012. SETTING:Postanesthesia care unit, intensive care ...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2016.05.009
更新日期:2016-11-01 00:00:00
abstract::A 37-year-old patient undergoing operative hysteroscopy developed noncardiogenic pulmonary edema after fluid absorption of 6 L of Ringer's lactate distension solution. No electrolyte or neurologic sequelae were associated with this fluid absorption. A subsequent 35-year-old patient having similar surgery in which a de...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2003.03.010
更新日期:2004-02-01 00:00:00
abstract:STUDY OBJECTIVE:To evaluate the opioid-sparing and analgesic effect of diclofenac sodium in ambulatory nonimmersion extracorporeal shock wave lithotripsy (ESWL). DESIGN:Randomized, double-blind, placebo-controlled study. SETTING:Large referral hospital. PATIENTS:Twenty-seven ASA physical status I and II patients wit...
journal_title:Journal of clinical anesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/0952-8180(93)90142-2
更新日期:1993-03-01 00:00:00
abstract:STUDY OBJECTIVE:To ascertain if coughing during emergence from general anesthesia can be suppressed with a modified endotracheal tube. DESIGN:Randomized, double-blind, controlled study. SETTING:Operating rooms at a university hospital. PATIENTS:46 adult ASA physical status I, II, and III patients requiring elective ...
journal_title:Journal of clinical anesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s0952-8180(01)00299-9
更新日期:2001-09-01 00:00:00
abstract::We report a case of recurrent ST-segment elevations totaling 7 times over 3 hours during subtotal gastrectomy and the early postoperative period in a patient with no history of coronary artery disease. Possible contributing factors include cold stimulus, epidural anesthesia, and inadequate depth of anesthesia. The fir...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2004.08.013
更新日期:2005-08-01 00:00:00
abstract:STUDY OBJECTIVE:To survey graduates from our residency program to determine their involvement and their interest in becoming certified in neonatal resuscitation. DESIGN:Survey questionnaire. SETTING:Graduates from the University of Pennsylvania Anesthesia Program between 1989 and 1999. SUBJECTS:212 individuals compl...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/s0952-8180(01)00285-9
更新日期:2001-08-01 00:00:00
abstract:STUDY OBJECTIVES:To examine whether epidural administration of neostigmine reduces the stress and inflammatory responses thereby improving postoperative pain status. DESIGN:Randomized, double-blinded clinical study. SETTING:Operating rooms and wards of a university hospital. PATIENTS:40 ASA physical status I patient...
journal_title:Journal of clinical anesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/j.jclinane.2003.12.009
更新日期:2004-11-01 00:00:00
abstract:STUDY OBJECTIVE:To understand anesthesiologists' and surgeons' risk attitudes about expected years of life. DESIGN:Prospective study. SETTING:Central operating rooms (ORs) in a university hospital. RESPONDENTS:122 anesthesiologists and surgeons. MEASUREMENTS AND MAIN RESULTS:A 7-page survey questionnaire regarding ...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/s0952-8180(00)00130-6
更新日期:2000-03-01 00:00:00
abstract:STUDY OBJECTIVE:To evaluate the accuracy of cardiac index (CI) as measured by echo-transesophageal Doppler monitoring (echo-TDM) with CI measured by the transpulmonary thermodilution technique. DESIGN:Prospective, observational study. SETTING:University hospital. PATIENTS:16 patients scheduled for elective lung canc...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2009.03.013
更新日期:2010-03-01 00:00:00
abstract:STUDY OBJECTIVE:To compare postoperative nausea, emesis, analgesia, and recovery between propofol-ketamine and propofol-fentanyl in outpatient laparoscopic tubal ligations with general anesthesia. STUDY DESIGN:Prospective, randomized, blinded study. SETTING:Tertiary-care women's hospital. PATIENTS:120 ASA physical s...
journal_title:Journal of clinical anesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s0952-8180(02)00391-4
更新日期:2002-09-01 00:00:00
abstract:OBJECTIVE:To examine the severity of cough and straining at the time of emergence from anesthesia. DESIGN:Double-blind randomized, placebo-controlled study. SETTING:University-affiliated hospital. PATIENTS:Sixty-two American Society of Anesthesiologists 2 patients undergoing craniotomy and excision of supratentorial...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jclinane.2015.09.001
更新日期:2016-09-01 00:00:00