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Biomedical subjects

A Fassoulaki

Publications and source records attributed to A Fassoulaki.

At least 19 recordsLinked to original sources

A combination of gabapentin and local anaesthetics attenuates acute and late pain after abdominal hysterectomy.

BACKGROUND AND OBJECTIVE: Gabapentin and local anaesthetics may decrease postoperative pain and analgesic needs. The aim of the study was to investigate the effect of the combination of these drugs on the analgesic needs as well as on acute and late pain after abdominal hysterectomy. METHODS: Sixty patients undergoing abdominal hysterectomy were randomly assigned to receive postoperatively oral gabapentin 400 mg 6 hourly for 7 days plus continuous wound infusion of ropivacaine 0.75% for 30 h or placebo capsules identical to those of gabapentin for 7 days and continuous wound infusion of normal saline for 30 h. Morphine consumption (PCA) for 48 h, paracetamol 500 mg plus codeine 30 mg (Lonalgal tablets) intake on days 3-7, visual analogue pain scores at rest and after cough during the first 7 postoperative days, the need for analgesics at home and the presence and incidence of pain after 1 month were recorded. RESULTS: The treatment group consumed less cumulative morphine over the first 48 h (31 +/- 13.2 mg vs. 50 +/- 20.5 mg in controls, P < 0.001) and less Lonalgal tablets on days 3-7 (z = 2.54, P = 0.011). The visual analogue score values at rest and after cough did not differ between the groups during the first 7 postoperative days. One month postoperatively, fewer patients in the treatment group experienced pain due to surgery than in the control group (17/27 vs. 21/24, P = 0.045). CONCLUSION: Gabapentin and continuous wound infusion with ropivacaine 0.75% decreased analgesic needs and late pain in patients undergoing abdominal hysterectomy.

Administration, Oral↗

Gabapentin attenuates the pressor response to direct laryngoscopy and tracheal intubation.

BACKGROUND: Laryngoscopy and tracheal intubation increase blood pressure and heart rate (HR). The aim of the present study was to investigate the effect of gabapentin when given before operation on the haemodynamic responses to laryngoscopy and intubation. METHODS: Forty-six patients undergoing abdominal hysterectomy for benign disease were randomly allocated to receive gabapentin 1,600 mg or placebo capsules at 6 hourly intervals starting the day (noon) before surgery. Anaesthesia was induced with propofol and cis-atracurium. Systolic, diastolic arterial blood pressures (SAP, DAP) and heart rate (HR) were recorded before and after the anaesthetic and 0, 1, 3, 5 and 10 min after tracheal intubation. RESULTS: SAP was significantly lower in the gabapentin vs the control group 0, 1, 3, 5 and 10 min after intubation [128 (27) vs 165 (41), P=0.001, 121 (14) vs 148 (29), P=0.0001, 115 (13) vs 134 (24), P=0.002, 111 (12) vs 126 (19), P=0.004 and 108 (12) vs 124 (17), P=0.001 respectively]. DAP also was lower in the gabapentin group 0, 1, 3, and 10 min after intubation [81 (18) vs 104 (19), P=0.0001, 77 (9) vs 91 (16), P=0.001, 71 (10) vs 84 (13), P=0.001 and 67 (10) vs 79 (12), P=0.004]. HR did not differ between the two groups at any time [82 (11) vs 83 (15), 79 (10) vs 80 (12), 86 (17) vs 92 (10), 82 (11) vs 88 (10), 81 (12) vs 81 (11), 77 (13) vs 79 (13), and 75 (15) vs 78 (12)]. CONCLUSION: Gabapentin, under the present study design attenuates the pressor response but not the tachycardia associated with laryngoscopy and tracheal intubation.

Adult↗

Gabapentin attenuates late but not acute pain after abdominal hysterectomy.

BACKGROUND AND OBJECTIVE: Gabapentin has been suggested to decrease acute postoperative pain. We evaluated the effect of gabapentin on pain after abdominal hysterectomy. METHODS: Sixty patients scheduled for abdominal hysterectomy were randomized to receive orally gabapentin 400 mg 6 hourly or placebo. Treatment started 18 h preoperatively and continued for 5 postoperative days. Pain (visual analogue score) and consumption of morphine for 48 h and of oral paracetamol/codeine were recorded after 2, 4, 8, 24 and 48 h and on days 3-5 postoperatively. After 1 month, patients were interviewed by phone for pain, and analgesic intake after hospital discharge. RESULTS: Morphine consumption (mean +/- SD) was 35 +/- 15.7 mg in the control and 28 +/- 12.1 mg in the gabapentin group (P = 0.21). Median number (range) of paracetamol 500 mg/codeine 30 mg tablets taken during days 3-5 was 1.0 (0-6) in the control and 2.0 (0-9) in the gabapentin group (P = 0.35). The visual analogue scores at rest and after cough did not differ between the two groups (F = 0.92, df = 1, P = 0.34 and F = 0.56, df = 1, P = 0.46, respectively). One month after surgery, 22/27 (81%) of the control group and 9/25 (36%) of the gabapentin group reported pain in the surgical area (chi(2) = 11.15, P = 0.002), while 11/27 (41%) of controls and 7/25 (28%) of gabapentin patients consumed analgesics for pain (chi(2) = 0.93, P = 0.39). The intensity of pain was decreased in the gabapentin group (chi(2) = 12.6, P = 0.003). CONCLUSIONS: Gabapentin has no effect on immediate pain after abdominal hysterectomy but decreases pain 1 month postoperatively.

Acetaminophen↗

Pre-oxygenation enhances induction with sevoflurane as assessed using bispectral index monitoring.

BACKGROUND: Several methods may enhance the inhalational induction of anesthesia. In this randomized double-blind study, we evaluated the speed of induction of anesthesia with sevoflurane with or without pre-oxygenation. METHODS: Fifty-four patients scheduled for hysteroscopy received for 10 min air or 100% oxygen via a facemask followed by > or = 7% sevoflurane in 100% oxygen. During the first 300 s of sevoflurane administration, bispectral index (BIS) values were recorded every 30 s in all patients. In 14 patients, seven in each group, BIS, endtidal CO(2), tidal volume, respiratory rate, SpO(2), and heart rate were recorded every minute during the pre-induction period and every 30 s during the first 5 min of sevoflurane administration. RESULTS: The BIS, endtidal CO(2), tidal volume and respiratory rate did not differ between the oxygen or air breathing groups (P = 0.696, P = 0.999, P = 0.388, and P = 0.875, respectively), though the oxygen group exhibited lower tidal volumes by 16-20%. The SpO(2) and heart rates were higher in the oxygen breathing group (P < 0.001 and P = 0.042, respectively). During sevoflurane administration, BIS values were lower in the oxygen group vs. the group breathing air, in particular at 90, 120, 150, 180 and 210 s (P = 0.001, P = 0.001, P = 0.001, P = 0.001 and P = 0.030, respectively). The endtidal CO(2) and the tidal volumes between the groups did not differ. The two groups differed in the SpO(2) and the heart rates during induction (P = 0.004 and 0.003, respectively). CONCLUSIONS: Before sevoflurane administration, breathing 100% oxygen for 10 min enhances induction of anesthesia with sevoflurane.

Adjuvants, Anesthesia↗

Sevoflurane as a single anesthetic and physostigmine failure to enhance arousal.

AIM: Sevoflurane is recommended for inhalational induction of anesthesia. Physostigmine may antagonize general anesthetics. The study investigates sevoflurane as a single anesthetic and its possible antagonism by physostigmine. METHODS: In 60 women scheduled for breast lump excision, anesthesia was induced with 8% sevoflurane. After 3 min of sevoflurane inhalation, a laryngeal mask airway (LMA) was inserted. Anesthesia was maintained with spontaneous ventilation at end tidal sevoflurane 3%. Systolic and diastolic blood pressure, heart rate and end tidal CO(2) were recorded intraoperatively. After skin closure and at end tidal sevoflurane 0.9%, physostigmine 2 mg or normal saline was given. After 2 min systolic, diastolic blood pressure, heart rate and end tidal CO(2) were recorded and sevoflurane was discontinued. Time to eyes opening, LMA removal and verbal response was recorded. Patients were also assessed for orientation, sedation, sitting ability and the ''picking up matches'' test at 0, 15 and 30 min after LMA removal. RESULTS: Systolic, diastolic blood pressure and heart rate increased after laryngeal mask placement (P=0.0001, P=0.0001 and P=0.0001, respectively). Orientation, sitting ability and ''picking up'' matches were similar in the 2 groups. Sedation at 15 min was less in the control group (P=0.004). CONCLUSIONS: Sevoflurane can be used as a single anesthetic but its recovery is not enhanced by physostigmine.

Anesthetics, Inhalation↗

Responses to mechanical and electrical stimuli are not attenuated by late pregnancy.

Pregnancy has been associated with increased pain threshold. This study investigates the responses to mechanical and electrical stimuli in pregnant and non-pregnant women. Thirty pregnant women were subjected before and four days after elective caesarean section under regional anaesthesia to mechanical and electrical stimuli on both forearms. Thirty nonpregnant women were subjected to the same stimuli at the same time points. The responses to mechanical stimuli were expressed in mm of the Visual Analogue Scale (VAS) and averaged for both forearms. The VAS scores obtained after the electrical stimuli were divided by the mA recorded when the stimulus was applied, expressed in mm/mA and averaged. The responses to mechanical stimuli recorded before and four days after application did not differ between the two groups (F = 0.884, df = 3,116, P = 0.452). In the pregnant group the VAS values before and four days after the caesarean section were 16.4 +/- 14.4 mm and 12.8 +/- 12.5 mm respectively. In the nonpregnant group the VAS values recorded four days apart were 17.5 +/- 14.3 mm and 13.4 +/- 11.9 mm respectively. The responses to electrical stimuli applied four days apart also did not differ between the two groups (F = 2.433, df = 3,116, P = 0.069). The VAS values obtained after the first and second application of the electrical stimulus were 0.914 +/- 0.606 mm/mA versus 0.586 +/- 0.410 mm/mA in the pregnant and 0.853 +/- 0.538 mm/mA versus 0.725 +/- 0.467 mm/mA in the nonpregnant group. These results, under the study conditions, do not support the hypothesis that late pregnancy is associated with increased antinociception in humans.

Adult↗

Spread of subarachnoid block, intraoperative local anaesthetic requirements and postoperative analgesic requirements in Caesarean section and total abdominal hysterectomy.

BACKGROUND: Pregnancy is associated with a higher spread of subarachnoid anaesthesia and increased pain threshold. The study was designed to assess the spread of subarachnoid block and the intra- and postoperative analgesic requirements in pregnant vs non-pregnant women. METHODS: We assessed the level of subarachnoid anaesthesia after 1.8 ml of hyperbaric lidocaine 5% and the postoperative analgesic requirements in women undergoing Caesarean section and undergoing abdominal hysterectomy (30 each group). Intraoperatively epidural ropivacaine was given as required. All patients received 10 ml of ropivacaine 0.2% epidurally 2, 10, and 24 h after operation and the VAS pain score was assessed. They also had access to patient controlled analgesia i.v. morphine. RESULTS: Duration of surgery was 64 (13.7) vs 127 (33.8) min (P<0.0001) in the pregnant and non-pregnant groups. Ten minutes after subarachnoid injection, sensory block was higher by three dermatomes in the pregnant group (P<0.0001). Time to first ropivacaine dose was 37 (19.7) vs 19 (12.2) min (P<0.001) and the ropivacaine normalized for the duration of anaesthesia was 0.8 (0.6) vs 1.3 (0.5) mg(-1) (P=0.001) in the pregnant and non-pregnant groups, respectively. The time between the first and second ropivacaine dose was similar in the two groups (P=0.070). Fewer pregnant women (81 vs 100%) required ropivacaine intraoperatively (P=0.017). The VAS scores were similar but parturients consumed more i.v. morphine (33 (14) vs 24 (12) mg, P=0.016) during the first 24 h after operation. CONCLUSIONS: Pregnant patients exhibited a higher level of subarachnoid sensory block and required more i.v. morphine after operation.

Adult↗

Needling of the extra 1 point decreases BIS values and preoperative anxiety.

Acupuncture has anxiolytic effects. We investigated the effect of acupuncture on the Bispectral Index (BIS) values and anxiety. Fifty patients were randomly assigned to group A to receive acupuncture for 15 minutes on the extra 1 point (yintang) or to group C, where they received the same treatment on a control point located 2 cm lateral to the end of the right eyebrow. BIS values were recorded before acupuncture; during acupuncture every 30 seconds for 15 minutes and every 30 seconds for 90 seconds when the acupuncture treatment was accomplished. Anxiety level was assessed before and after acupuncture by a verbal score scale (VSS) (0 = no anxiety, 10 = worst anxiety). BIS values were significantly decreased during acupuncture when applied on the extra 1 point (p = 0.0001) but not on the control point. Acupuncture application significantly decreased the VSS values within the A group (p = 0.027) and in the C group (p = 0.0001), when compared to the baseline (pre-acupuncture) VSS values. However, no differences were found between the two groups regarding BIS or VSS values. In conclusion, needling the extra 1 point preoperatively significantly decreases the BIS values and the VSS for anxiety but needling of a control point decrease only VSS values.

Acupuncture Points↗

Direction and side used to determine the extent of sensory block after subarachnoid anesthesia do not influence the level of the block.

Methods of sensory testing in neuraxial anesthesia may supposedly account for different results in reporting the extent of the block. To determine whether the caudad to cephalad versus the cephalad to caudad direction as well as the side of testing, left versus right, may affect the assessment of sensory block after subarachnoid anesthesia, two groups of patients undergoing transurethral surgery were studied. One group, 44 patients were tested for the influence of direction of block determination and another group 50 patients for the influence of side. Subarachnoid anesthesia was performed with 100 mg of 5% hyperbaric lidocaine using a 25 Whitacre needle with its opening consistently pointing cranially and the patient in the sitting position. To assess the sensory block four lines were drawn bilaterally along the posterior, middle, and anterior axillary lines and a line 5 cm medial to the anterior axillary line. A pressure palpator was moved along each of the four lines and patients were asked to answer if they detected a stimulus, with "yes/no". In the 44 patients assessment of sensory block was performed from caudad to cephalad direction on one side and viceversa on the other. In the other 50 patients the extent of the block was compared between the right and left side. In 44 patients, the level of sensory block determined 20, 25 and 30 minutes after the subarachnoid anesthesia in a cephalad to caudad direction was found at the T11 dermatome at each time point and did not differ when compared to the levels determined following the caudad to cephalad direction. In the second study in a different group of 50 patients, the level of sensory block 20, 25 and 30 minutes after the subarachnoid injection was found at the T11 dermatome on the right side at each time point and did not differ from the level determined on the left side. We conclude that the level of sensory block after subarachnoid anesthesia with lidocaine is independent of the direction of testing and the side the assessment is performed using the pressure palpator.

Aged↗

Transdermal clonidine: does it affect pain after abdominal hysterectomy?

Clonidine has analgesic properties. We evaluated the analgesic effect of clonidine perioperatively. Forty patients undergoing abdominal hysterectomy received randomly the evening before surgery transdermal clonidine covered with overlay (CLO group) or the overlay alone (CTL group). Ten min before induction they received i.v. clonidine 1 microgram.kg-1 (CLO) or normal saline (CTL). Induction was accomplished with fentanyl 5 micrograms.kg-1, thiopentone 5 mg.kg-1, cis-atracurium 0.15 mg.kg-1 and maintenance with sevoflurane 2% in 70% N2O. Hemodynamic parameters were recorded intraoperatively. Pain was assessed by VAS at rest and movement 2, 4, 6, 8, 24, 48, 72 h and 30 days, postoperatively. During the first 8 h postoperatively all patients received controlled analgesia with fentanyl followed by morphine i.m. 0.15 mg.kg-1 and paracetamol. From 24-72 h postoperatively, patients received 75 mg propoxyphene and 600 mg paracetamol i.m., on demand. Arterial blood pressure was lower in the CLO group 0, 3, 10 min after intubation. There was no difference in pain or fentanyl consumption 8 h postoperatively. The CLO group required less analgesics 24 h postoperatively (p = 0.023). The two groups did not differ in pain or analgesic requirements 72 h and 30 days postoperatively. Clonidine had a weak opioid sparing effect 24 h post-operatively, but did not affect pain in long term.

Administration, Cutaneous↗

Impact factor bias and proposed adjustments for its determination.

BACKGROUND: The impact factor (IF), a qualitative parameter used to evaluate scientific journals, has several flaws. The aim of the study was to evaluate two of its important constraints, journal self-citation and scientific field, and to investigate the potential for improvement. METHODS: We studied the five or six highest impact journals from each of seven medical fields: anesthesiology, dermatology, genetics and heredity, immunology, general and internal medicine, ophthalmology and surgery. To correct for journal self-citation, we divided the number of 1998 citations of papers published in 1996 and 1997, minus the self-citations, by the number of papers published in the same period. For inter-field normalization we divided the IF by the mean of the IFs of the upper quartile for the same category of medical field (IF/fcat). RESULTS: For the 36 journals, there was a negative correlation between IF and self-cited and self-citing rates (rs = -0.765, P < 0.001 and rs = -0.479, P < 0.003, respectively). Self-cited rate is the ratio of a journal's self-citations to the number of times it is cited by all journals including itself. Self-citing rate relates a journal's self-citations to the total references it makes. The IF/fcat for the 36 journals are positively correlated with their conventional IF (rs = 0.91, P < 0.001). CONCLUSION: Correcting the IF of the 36 journals for self-citation did not significantly change journal rankings. The adjusted IF/fcat to normalize for the scientific field was positively correlated with the conventional IF.

Bibliometrics↗

Academic anesthesiologists' views on the importance of the impact factor of scientific journals: a North American and European survey.

PURPOSE: To investigate the views of North American and European anesthesiologists on the value of the impact factor (IF). METHOD: Four hundred thirty-eight anesthesiologists in Canada, the United States of America (USA), and Europe were polled about the importance of the IF regarding hiring, promotions, funding of research and to express their personal views. RESULTS: IF of a candidate's publications is a criterion in 38% of academic appointments in Canada and USA vs 81% in Europe (P <0.0001). The importance of IF to obtain funding is greater in Europe (46%) than in North America (17%) (P <0.0001). Twenty-three percent and 50% of Canadian and American anesthesiologists respectively believe that IF affects financial support (P=0.0389). European anesthesiologists value the IF more than the North Americans (67% vs 31%, P <0.0001). Forty-five percent, 67%, and 56% of the Canadian, American and European anesthesiologists respectively estimate that IF reflects journal quality. Sixty-four percent of anesthesiologists in North America vs 81% in Europe (P=0.0175) pursue to publish in high IF journals. Eighty-six percent, 85% and 90% of the Canadian, American and European anesthesiologists believe that the IF of a journal can be manipulated. Finally, 79%, 67%, and 81% of the Canadian, American, and European anesthesiologists believe that IF should be improved but 33%, 35%, and 30% believe that it should be abandoned. CONCLUSIONS: IF for academic appointments and funding is more important in Europe than in North America. More than 50% of anesthesiologists agree that IF needs to be improved.

Anesthesiology↗

Hypnotic and cardiovascular effects of proprietary and generic propofol formulations do not differ.

PURPOSE: The aim of the study was to compare the potency of two different propofol formulations: proprietary and generic propofol using the bispectral index (BIS) monitoring. METHODS: Forty female patients undergoing breast surgery received propofol 3 mg x kg(-1) followed by propofol infusion adjusted to maintain a 40% BIS value, supplemented by 50% nitrous oxide. Proprietary or generic propofol was administered in a randomized double-blind manner. RESULTS: The propofol mg/BIS% ratio obtained after the bolus dose, the cumulative infused propofol mg/BIS% ratio at the end of each five-minute interval and the total dose of propofol administered as bolus + infusion were similar between the two groups. The two groups did not differ with regard to systolic and diastolic blood pressure, heart rate, end-tidal carbon dioxide and arterial oxygen saturation. CONCLUSION: The two propofol formulations are equipotent when hypnotic effect is assessed by BIS monitoring.

Adult↗

Self-citations in six anaesthesia journals and their significance in determining the impact factor.

Self-citation of a journal may affect its impact factor. We investigated self-citations in the 1995 and 1996 issues of six anaesthesia journals by calculating the self-citing and self-cited rates for each journal. Self-citing rate relates a journal's self-citations to its total number of references. We defined self-cited rate as the ratio of a journal's self-citations to the number of times it is cited by the six anaesthesia journals. We also correlated self-citing rates with the impact factor of the six journals for 1997. Citations among the six journals differed significantly (P < 0.0001). Anesthesiology had the highest self-citing rate (57%). Anaesthesia, Anesthesia and Analgesia, British Journal of Anaesthesia, Canadian Journal of Anaesthesia and the European Journal of Anaesthesiology had self-citing rates of 28%, 28%, 30%, 11% and 4% respectively. The self-cited rates were 31%, 35%, 34%, 27%, 31% and 17% for Anaesthesia, Anesthesiology, Anesthesia and Analgesia, British Journal of Anaesthesia, Canadian Journal of Anaesthesia and the European Journal of Anaesthesiology, respectively. North America journals cited the North America literature. This also occurred, to a lesser extent, in the European anaesthesia journals. A significant correlation between self-citing rates and impact factors was found (r = 0.899, P = 0.015). A high self-citing rate of a journal may positively affect its impact factor.

Anesthesiology↗

The analgesic efficacy of intravenous tenoxicam as an adjunct to patient-controlled analgesia in total abdominal hysterectomy.

UNLABELLED: Nonsteroidal antiinflammatory drugs may reduce postoperative opioid consumption. We evaluated the analgesic efficacy of preoperatively administered tenoxicam in patients undergoing total abdominal hysterectomy. Patients were randomly assigned to receive IV either normal saline 4 mL (Group NS), tenoxicam 20 mg (Group T20), or tenoxicam 40 mg (Group T40) before the induction of anesthesia in a double-blinded fashion. Patient-controlled analgesia with fentanyl was used to assess postoperative opioid requirements. Pain was evaluated by visual analog scale at 2, 4, 6, 8, and 24 h postoperatively. Intraoperative bleeding as assessed by the surgeon, incidence of nausea, and gastrointestinal symptoms were recorded. No statistically significant difference was identified between groups in fentanyl consumption or pain scores. The incidence of nausea was similar in all groups. Two patients in Group T20 and two in Group T40 exhibited mild gastrointestinal symptoms. Intraoperative oozing was noted in two patients in Group T40. We conclude that patients undergoing total abdominal hysterectomy and receiving fentanyl via patient-controlled analgesia postoperatively do not benefit from tenoxicam pretreatment. On the contrary, the drug may be associated with an increased incidence of side effects. IMPLICATIONS: The preoperative administration of 20 or 40 mg IV tenoxicam does not reduce fentanyl consumption via Patient-Controlled Analgesia, compared with placebo, after total abdominal hysterectomy. Additionally, tenoxicam may increase intraoperative bleeding and gastrointestinal side effects.

Adult↗

Assessment of the level of sensory block after subarachnoid anesthesia using a pressure palpator.

UNLABELLED: In a cross-over study, we compared two methods of assessing the level of sensory block during subarachnoid anesthesia: the traditional pinprick sensation or a novel pressure palpator exerting a pressure of 650 g. Fifty patients scheduled for transurethral surgery under subarachnoid anesthesia were randomly assigned to be tested for spread of sensory block. In Group 1, the pressure palpator was followed by pinprick; in Group 2, the reverse sequence was used. Evaluation was performed 15 and 25 min after the subarachnoid injection of 2 mL of 5% lidocaine hyperbaric solution. In Group 1, the level of sensory block assessed with the pressure palpator was 1.7 +/- 3.2 cm (0.5 +/- 1.2 dermatomes) higher than that with the pinprick at 15 min, and 2.2 +/- 3.4 cm (0.6 +/- 1.0 dermatomes) higher than that with the pinprick 25 min after the block. In Group 2, the difference was accentuated. The level of sensory block assessed by pinprick 15 min after subarachnoid lidocaine was 5.7 +/- 4.8 cm (1.2 +/- 0.9 dermatomes) lower than the level with the pressure palpator, and 4.2 +/- 3.3 cm (0.9 +/- 0.6 dermatomes) lower than that with the pressure palpator at 25 min. In all instances, the pressure palpator gave a significantly higher assessment than the pinprick. We conclude that the pressure palpator, when preceded by the pinprick test, is associated with an increased threshold. This method may be useful in assessing the sensory block produced by subarachnoid anesthesia. IMPLICATIONS: A novel pressure palpator that maintains the integrity of the epidermis was used to assess the level of sensory block after subarachnoid anesthesia and was compared with the standard method of the pinprick sensation. This method assessed the block consistently higher than the pinprick method, but it may have advantages as a noninvasive sensory test.

Aged↗