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Biomedical subjects

S P Kothary

Publications and source records attributed to S P Kothary.

14 recordsLinked to original sources
PubMed1989

Intravenous narcotics for premedication in outpatient anaesthesia.

One hundred adult female patients scheduled for outpatient laparoscopic procedures were studied. Each patient received intravenous premedication about 30 min before induction of anaesthesia. The premedications were given in a double-blind random order and were either a placebo, morphine (0.04 mg/kg), meperidine (0.35 mg/kg), fentanyl (0.75 microgram/kg) or sufentanil (0.15 microgram/kg). All patients received a standard anaesthetic regimen. Transient light-headedness was common following narcotic injections. Overall, sufentanil was superior to the placebo and to other narcotics in its ability to reduce preoperative anxiety and to provide more satisfactory induction, maintenance and recovery from anaesthesia. The incidence of postoperative nausea, vomiting and other side effects was not higher and discharge times were not longer after sufentanil compared to the placebo group. Complete recovery as assessed by telephone interview 24-48 h after the operation revealed no difference between the sufentanil and the other groups. The results of this study indicate that intravenous short-acting narcotics like fentanyl or sufentanil should be considered as an alternative premedicant for anxious patients who are scheduled for outpatient surgery.

Adolescent↗
PubMed1987

Comparison of fentanyl and butorphanol for outpatient anaesthesia.

Equianalgesic doses of butorphanol (40 micrograms X kg-1) and fentanyl (2.0 micrograms X kg-1) were compared as supplements to balanced general anaesthesia for outpatient laparoscopic procedures. Thirty-six adult female patients (ASA physical status I or II) participated in the study. The study drugs (butorphanol or fentanyl) were given just prior to induction of anaesthesia in a double-blind fashion. Following induction with a standard dose of thiopentone and tracheal intubation using succinylcholine, nitrous oxide in oxygen and a succinylcholine infusion were used for maintenance of anaesthesia. Seventeen of the 18 patients in the butorphanol group and 14 of the 18 patients in the fentanyl group showed signs of light anaesthesia and required supplementation with isoflurane. Induction, maintenance and recovery characteristics were not different in the two groups except that the post-intubation arterial pressure and heart rate in the fentanyl group were significantly higher than the base line values and the patients receiving butorphanol were more drowsy and also more pain-free in the postoperative period. The incidence of nausea and vomiting was high in both groups. Overall, butorphanol (40 micrograms X kg-1) used as part of a standard balanced general anaesthetic for a standard outpatient procedure was not superior to fentanyl (2 micrograms X kg-1) used in the same fashion.

Adult↗
PubMed1986

Intravenous dezocine for postoperative pain: a double-blind, placebo-controlled comparison with morphine.

Dezocine, a new mixed agonist-antagonist opioid analgesic, and morphine were compared in a double-blind study in 206 patients with postoperative pain. The analgesic efficacy of single intravenous injections of dezocine (2.5, 5.0, and 10.0 mg), morphine (5.0 mg), and placebo was assessed by verbal and visual scales at regular intervals for six hours after administration. All active treatments provided greater pain relief than placebo. Pain relief with dezocine 5 and 10 mg was significantly greater (P less than .05) than with placebo for up to four and five hours, respectively, and with morphine up to one hour. Pain relief scores were significantly higher (P less than .05) with morphine than with placebo at all observations except that of the fifth hour, and higher with dezocine 2.5 mg than with placebo for the first 30 minutes. Doses of 5 and 10 mg of dezocine produced approximately the same peak analgesic effect, with the larger dose having a longer duration of effect. All active treatments produced mild to moderate sedation. Side effects were few and mild or moderate with all of the treatments. The physician's and the patients' evaluations favored dezocine in a dose-dependent order, with morphine 5 mg rated lower than dezocine 5 mg and higher than dezocine 2.5 mg.

Adolescent↗
PubMed1985

Double-blind placebo-controlled comparison of dezocine and morphine for post-operative pain relief.

Dezocine, a new mixed agonist-antagonist-type opioid analgesic, was compared in a double-blind trial with placebo and 10 mg of morphine in 190 patients with acute postoperative pain. The medications were given intramuscularly. Dezocine was administered at three dose levels (5, 10, and 15 mg). Pain relief scores, sedation, and side effects were recorded at 15, 30, 60, 120 and 240 min after injection. Significantly higher pain relief scores (p less than 0.05) were reported for the groups receiving dezocine 10 and 15 mg than the placebo group at all observation times, except for dezocine 15 mg at four hours. Morphine produced significantly better pain relief than placebo only between the second and fourth hour after administration. Significantly better pain relief was obtained with dezocine (10 and 15 mg) than with morphine during the first hour. The mean four-hour cumulative pain relief scores (TOTPAR) were significantly (p less than 0.05) higher than placebo for all active treatment groups. Side effects were few with no significant differences between the treatment groups. Seventy-nine per cent of the patients in the dezocine 15 mg group, and 73, 68, 58 and 50 per cent respectively, of the patients in the dezocine 10 mg, dezocine 5 mg, morphine 10 mg and placebo group had a satisfactory clinical response. Significantly (p less than 0.05) more patients in the groups receiving dezocine 10 and 15 mg than in the placebo group had a satisfactory clinical response; the difference was not significant for the dezocine 5 mg and morphine 10 mg groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Analgesics, Opioid↗
PubMed1979

Floride inhibition in patients with atypical dibucaine-resistant plasmacholinesterase.

The fluoride numbers (FN) of 144 individuals referred to our laboratory for dibucaine number (DN) determinations because of prolonged apnea following succinylcholine in the probands or relatives were determined by our new method using 2.5 X 10(4) M concentration of sodium fluoride at 37 C. Dibucaine-resistant homozygotes and heterozygotes both had lower FN than the normal homozygotes. A linear correlation between DN and FN for all these genotypes was found which is described by the equation FN = 0.59 DN + 32. The correlation coefficient was r = 0.94. This equation will help in the correct identification of atypical fluoride resistant genotypes, since these ought to have an observed FN lower by 2 standard deviations than the FN calculated from this equation.

Apnea↗
PubMed1978

Plasma free norepinephrine and epinephrine concentrations following diazepam-ketamine induction in patients undergoing cardiac surgery.

Ketamine causes cardiovascular stimulation, presumably, by increasing central sympathetic activity. This study was undertaken to find out if diazepam in appropriate doses could abolish or moderate the central sympathetic and cardiovascular stimulation following ketamine in patients undergoing cardiac surgery. Twelve patients, scheduled for valvular replacement (8) and direct aortocoronary bypass graft operations (4) were studied. After premedication with diazepam 0.15 mg/kg orally and morphine sulphate 0.15 mg/kg i.m., they were induced with diazepam 0.3 mg/kg i.v., followed 10 min later by ketamine 2 mg/kg i.v. Direct arterial pressure by a strain gauge from the radial artery and heart rate by EKG were continuously recorded. Plasma free norepinephrine, measured by Vendsalu's method, in the arterial blood was 0.39 +/- 0.03 ng/ml prior to induction, 0.39 +/- 0.03 ng/ml 10 min after diazepam and 0.42 +/- 0.05 ng/ml (P greater than 0.05) 5 min after ketamine administration. Plasma free epinephrine concentrations were 0.10 +/- 0.04 ng/ml prior to induction, 0.06 +/- 0.03 ng/ml (P less than 0.05) 10 min after diazepam and 0.01 +/- 0.003 ng/ml (P less than 0.05) 5 min after ketamine. Heart rate and systolic pressure did not change significantly throughout the study period. Diastolic pressures were elevated significantly (P less than 0.05) 5 min after ketamine administration, amounting to a 12% increase over baseline. Diazepam-ketamine induction in cardiac surgical patients did not result in clinically significant central sympathetic or cardiovascular stimulation.

Aged↗
PubMedDate not supplied

Propofol versus thiamylal-enflurane anesthesia for outpatient laparoscopy.

STUDY OBJECTIVE: To determine whether propofol anesthesia differs from thiamylal-enflurane anesthesia in induction characteristics, intraoperative hemodynamics, postoperative side effects, and postoperative psychomotor function recovery. DESIGN: A randomized, double-blind, two-group study. SETTING: A large university hospital with gynecologic outpatient operations performed in an integrated operating room suite. PATIENTS: Sixty adult women (ASA physical status I or II) undergoing an outpatient gynecologic laparoscopic operation with an anesthesia time of approximately 60 minutes. INTERVENTIONS: No pharmacologic premedication. Pretreatment with intravenous droperidol 0.6 mg and sufentanil 0.2 micrograms/kg before induction of anesthesia. Anesthesia was induced with either thiamylal 4 mg/kg (Group 1) or propofol 2.5 mg/kg (Group 2). Anesthesia was maintained with either nitrous oxide (N2O) and enflurane, 2-0.5% inspired concentrations; (Group 1) or with a continuous infusion of propofol 200-100 micrograms/kg/min and N2O (Group 2). MEASUREMENTS AND MAIN RESULTS: In psychomotor function tests (Trieger dot test and p-deletion test) administered preoperatively and postoperatively, no difference was found between the groups. No difference was found in induction time, although significantly more patients reported pain after the propofol injection, or in intraoperative hemodynamics (mean arterial pressure and heart rate). Immediate recovery time (emergence from anesthesia) and intermediate recovery time (ambulation, oral intake, and discharge time) were significantly shorter after propofol anesthesia. Fewer postoperative side effects, such as nausea and vomiting, were reported after propofol anesthesia. CONCLUSIONS: Induction and maintenance of anesthesia with propofol were comparable to those with thiamylal-enflurane, except patients experienced more pain on injection after propofol. Both immediate and intermediate recovery were more rapid after propofol anesthesia compared with enflurane-based anesthesia.

Adult↗
PubMedDate not supplied

Arterial hypoxemia caused by intravenous ketamine.

Ketamine given IV in a dose of 2 mg/kg caused a significant reduction in Pao2 in 7 patients spontaneously breathing with an unassisted airway. Under the same conditions, in 7 patients, ketamine (2 mg/kg IV) preceded by diazepam (0.2 mg/kg IV) also caused a reduction in Pao2 not significantly different from that caused by ketamine. In some patients, alarmingly low levels of Pao2 ( less than or equal to 40 torr) were seen following ketamine administration. Based on these findings, the authors recommend that O2 and ventilatory assistance accompany ketamine given IV for anesthesia.

Anesthesia, Intravenous↗