An intraoperative pre-incision single dose of intravenous ketamine does not have an effect on postoperative analgesic requirements under clinical conditions.

Evidence about the effectiveness of the N-methyl-D-aspartate antagonist ketamine to reduce postoperative acute and long-lasting pain is inconclusive. The aim of this study was to investigate effects of adding an intraoperative, pre-incision single intravenous dose of ketamine to a routine anaesthesia regimen on postoperative analgesic requirements, side-effects and persisting pain up to three months. After obtaining Ethical Committee approval and written informed patient consent, 120 patients were included in this prospective, randomised, double-blinded, placebo-controlled study. Patients were randomised into three groups, receiving 0.15 mg/kg ketamine intravenously, 0.5 mg/kg ketamine intravenously or normal saline in groups low-dose ketamine, moderate-dose ketamine and placebo, respectively. Anaesthesia maintenance, intraoperative pain management and postoperative pain therapy were standardised. The primary study endpoint was consumption of morphine during the first 24 hours after surgery. Three months after surgery, pain scores were assessed. Data were compared by t-test and Kruskall-Wallis test with alpha = 0.05. There was no difference between the groups in the assessed variables. These findings indicate that with the anaesthesia regimen described, and in the doses used, a single intravenous dose of ketamine does not reduce postoperative analgesic requirement or postoperative pain at three months.

Effect of rofecoxib on platelet aggregation and blood loss in gynaecological and breast surgery compared with diclofenac.

BACKGROUND: Non-selective cyclooxygenase (COX) inhibitors or non-steroidal anti- inflammatory drugs (NSAIDs) are frequently omitted for perioperative pain relief because of potential side-effects. COX-2-selective inhibitors may have a more favourable side-effect profile. This study tested the hypothesis that the COX-2-selective inhibitor rofecoxib has less influence on platelet function than the NSAID diclofenac in gynaecological surgery. In addition, analgesic efficacy and side-effects of the two drugs were compared. METHODS: In this single-centre, prospective, double-blind, active controlled study, women undergoing vaginal hysterectomy (n=25) or breast surgery (n=25) under general anaesthesia received preoperatively 50 mg of rofecoxib p.o. followed 8 and 16 h later by two doses of placebo or three doses of diclofenac 50 mg p.o. at the same time points. We assessed arachidonic acid-stimulated platelet aggregation before and 4 h after the first dose of study medication, estimated intraoperative blood loss, and haemoglobin loss until the first morning after surgery. Analgesic efficacy, use of rescue analgesics, and side-effects were also recorded. RESULTS: In the rofecoxib group, stimulated platelet aggregation was disturbed less (P=0.02), and estimated intraoperative blood loss (P=0.01) and the decrease in haemoglobin were lower (P=0.01). At similar pain ratings, the use of anti-emetic drugs was less in the rofecoxib group (P=0.03). CONCLUSION: Besides having a smaller effect on platelet aggregation, one oral dose of rofecoxib 50 mg given before surgery provided postoperative analgesia similar to that given by three doses of diclofenac 50 mg and was associated with less use of anti-emetics and less surgical blood loss in gynaecological surgery compared with diclofenac.

Laryngeal mask airway and high-frequency jet ventilation for the resection of a high-grade upper tracheal stenosis.

The surgical resection of a high-grade tracheal stenosis presents a special case of a difficult airway. A 20-year-old male was treated for a 45-mm long tracheal stenosis with 60% reduction of the patent airway area beginning 25 mm below the glottis. To avoid manipulations of the affected segment before surgical exposure of the trachea was established, strictly supraglottic ventilation via a laryngeal mask airway was performed. During removal of the stenosis and creation of the anastomosis, transglottic high-frequency jet ventilation (HFJV) is a convenient technique that enables optimal access to the operation field. Changing from HFJV to conventional ventilation after completion of the anastomosis is not necessary, and the jet catheter can be left in place until the end of the anesthesia.