The Efficacy of Propofol vs. Subcutaneous Sumatriptan for Treatment of Acute Migraine Headaches in the Emergency Department: A Double-Blinded Clinical Trial.

BACKGROUND: In this double-blinded, randomized trial, we hypothesized that propofol is as effective as sumatriptan in treating acute migraine headaches, with better control of nausea and vomiting, and fewer side effects. METHODS: Ninety cases of acute migraine attack admitted to the emergency department were randomly allocated into two treatment groups: (1) 6 mg of sumatriptan subcutaneously or (2) propofol injected intravenously in 30 to 40 mg boluses, followed by 10 to 20 mg intermittent bolus doses to sedate the patients to Ramsey score of 3 to 4. Headache severity was assessed using an 11-point visual analog scale before treatment and 30 minutes, 1 hour, and 2 hours after treatment. Accompanying symptoms, improvement in headache, and the need for anti-emetic therapy were also assessed. RESULTS: A total of 91 patients were enrolled in this study. One patient in the sumatriptan group was excluded due to severe chest tightness, and 90 patients were included in the final analysis. Pain intensity was significantly lower in the propofol group 30 minutes after treatment (P = 0.001); however, after 1 and 2 hours, there were no significant differences between the groups. The need for anti-emetic therapy and the recurrence of symptoms were significantly lower in the propofol group (P = 0.045 and P = 0.001, respectively). CONCLUSION: Propofol is equally suitable as sumatriptan for the acute treatment of migraine headaches in an emergency department setting. Moreover, the use of propofol avoids some of the adverse side effects of sumatriptan while providing better control of nausea and vomiting.

Effect of preoperative administration of intravenous paracetamol during cesarean surgery on hemodynamic variables relative to intubation, postoperative pain and neonatal apgar.

Selection of anesthetic drugs for cesarean section requires many considerations. Anesthetic drugs for this purpose must prevent hemodynamic stress due to tracheal intubation, while inducing neonatal complications. This study was conducted to determine the effects of paracetamol given before induction of anesthesia on cardiovascular responses to tracheal intubation and postoperative pain in the mother, and on neonatal Apgar score. This double-blind randomized placebo-controlled trial included 60 women in ASA I, without underlying diseases and fetal distress, who were candidates for elective cesarean section under general anesthesia. Patients were divided into two groups of 30 patients. Patients in the paracetamol group received 1 g intravenous (IV) paracetamol 20 min before the operation, while those in the placebo group received 1 cc normal saline at the same time. In both groups, anesthesia was induced by sodium thiopental and succinylcholine. Maternal systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and heart rate (HR) were measured before and immediately upon induction of anesthesia, and at first and fifth minute after tracheal intubation. Neonatal effects were assessed by Apgar score. Postoperative pain was assessed by use of the visual analog scale (VAS). The dose of analgesic used and the time of the first analgesic request by patients postoperatively were recorded. The SBP, DBP, MAP and HR were controlled significantly better in paracetamol group than in placebo group (P < 0.05). The mean 1-min and 5-min Apgar scores of neonates did not differ between the groups. The VAS pain score was significantly lower in paracetamol group than in placebo group at all measuring times (P < 0.05). Also, paracetamol caused later first analgesic request and lower dose of analgesic needed to control pain postoperatively (P < 0.05). In conclusion, the results of our study suggested IV paracetamol to be an efficacious agent to decrease hemodynamic responses to tracheal intubation, while providing better postoperative pain management without considerable neonatal complications in women undergoing cesarean section in general anesthesia.

Reduced morphine consumption and pain severity with transdermal fentanyl patches following total knee arthroplasty.

PURPOSE: To determine the effects of transdermal fentanyl patches (TFPs) for postoperative analgesia in patients undergoing total knee arthroplasty (TKA) surgery. METHODS: A randomized, double-blind, controlled trial study of 40 ASA I-III patients undergoing TKA surgery was performed under general anaesthesia. Patients were randomly divided into two groups. Group I (n = 20) received two 25 µg TFPs placed on the laterals of chest wall approximately 12 h before induction of general anaesthesia. Group II, the control group (n = 20), received placebo patches of identical size. Postoperative pain at rest was assessed with visual analogue scale (VAS) at 0, 30 min and 2, 4, 6, 12, 24, 48 and 72 h. Total rescue consumption of morphine was estimated with patient control analgesia during the first 72 h after operation. The degree of active knee flexion and incidence of side effects were also evaluated. RESULTS: The VAS scores at 2, 4, 6, 12, 24, 48 and 72 h were significantly less in the group I compared to the group II (p < 0.05). Total morphine consumption was significantly less in group I than in group II (p < 0.05). No significant differences were found between the groups in the postoperative active knee flexion (n.s.). Side effects were similar between the groups. CONCLUSIONS: Transdermal fentanyl patches provide effective pain relief and decrease total rescue morphine consumption during the first 72 h after operation without additive side effects in patients undergoing TKA surgery.

Remifentanil at induction of general anesthesia for cesarean section: Double blind,randomized clinical trial / Remifentanilo en la inducción de la anestesia general para la cesárea: estudio clínico doble ciego, aleatorizado

Introduction: Remifentanil, with its rapid activity onset and short duration of action, may be more effective than other opioids for providing hemodynamic stability during obstetric anesthesia. However, there is some evidence of adverse effects on neonatal respiratory function. We investigated maternal and fetal effects of Remifentanil during cesarean section surgery. Methods: Eighteen women with singleton term pregnancies, and physical class status of I or II as defined by the American Society of Anesthesia (ASA), who were undergoing general anesthesia for semi-elective cesarean section were randomized into two groups (40 in each group) that received either an intravenous bolus of 0.5 µg/kg Remifentanil or the same dose of saline as a placebo. Maternal hemodynamic variables and neonatal umbilical artery pH and Apgar score at first and fifth min were evaluated in both groups. Results: Systolic and diastolic blood pressure were significantly lower after tracheal intubation and skin incision in the Remifentanil group as compared with the control group (p<0.05). There were no significant differences regarding heart rate between groups at any time (p> 0.05). Apgar scores at first and fifth min were not significantly different among groups (p>0.05). No neonate required assisted ventilation or naloxan administration. Conclusion: Remifentanil may be a safe and effective drug for the induction of general anesthesia and surgical stimulation without subsequent neonatal depression.

Introducción: El Remifentanilo, con su rápido comienzo de actividad y corta duración de acción, puede ser más eficaz que otros opioides para proporcionar la estabilidad hemodinámica durante la anestesia obstétrica. Sin embargo, hay alguna evidencia de efectos adversos sobre la función respiratoria neonatal. Se investigaron los efectos maternos y fetales de Remifentanilo durante la cirugía cesárea. Métodos: Dieciocho mujeres con embarazo de feto uno y con clasificación Asa I o II (sociedad americana de anestesiología) y que fueron sometidas a anestesia general para ces´rea semi eletiva, se dividieron aleatoriamente en dos grupos (40 mujeres en cada grupo) que recibieron un bolo intravenoso de 0.5 mm/Kg de remifentanil o en el grupo control la misma dosis de solución salina como placebo. Se evaluaron las variables hemodinámicas maternas y pH de la arteria umbilical neonatal y la puntuación de Apgar al primer y quinto minuto en ambos grupos. Resultados: La presión arterial sistólica y diastólica fueron significativamente más bajos después de la intubación traqueal y la incisión de la piel en el grupo Remifentanilo en comparación con el grupo control (p <0,05). No hubo diferencias significativas en cuanto a la frecuencia cardíaca entre los grupos en cualquier tiempo (p> 0,05). Las puntuaciones de Apgar a los minutos primero y quinto no fueron significativamente diferentes entre los grupos (p> 0,05). No neonato requiere ventilación asistida o administración naloxan. Conclusión: El Remifentanilo puede ser un fármaco seguro y eficaz para la inducción de la anestesia general y la estimulación quirúrgica sin depresión neonatal posterior.

Remifentanil at induction of general anesthesia for cesarean section: Double blind,randomized clinical trial.

INTRODUCTION: Remifentanil, with its rapid activity onset and short duration of action, may be more effective than other opioids for providing hemodynamic stability during obstetric anesthesia. However, there is some evidence of adverse effects on neonatal respiratory function. We investigated maternal and fetal effects of Remifentanil during cesarean section surgery. METHODS: Eighteen women with singleton term pregnancies, and physical class status of I or II as defined by the American Society of Anesthesia (ASA), who were undergoing general anesthesia for semi-elective cesarean section were randomized into two groups (40 in each group) that received either an intravenous bolus of 0.5 µg/kg Remifentanil or the same dose of saline as a placebo. Maternal hemodynamic variables and neonatal umbilical artery pH and Apgar score at first and fifth min were evaluated in both groups. RESULTS: Systolic and diastolic blood pressure were significantly lower after tracheal intubation and skin incision in the Remifentanil group as compared with the control group (p <0.05). There were no significant differences regarding heart rate between groups at any time (p > 0.05). Apgar scores at first and fifth min were not significantly different among groups (p>0.05). No neonate required assisted ventilation or naloxan administration. CONCLUSION: Remifentanil may be a safe and effective drug for the induction of general anesthesia and surgical stimulation without subsequent neonatal depression.

INTRODUCCIÓN: El Remifentanilo, con su rápido comienzo de actividad y corta duración de acción, puede ser más eficaz que otros opioides para proporcionar la estabilidad hemodinámica durante la anestesia obstétrica. Sin embargo, hay alguna evidencia de efectos adversos sobre la función respiratoria neonatal. Se investigaron los efectos maternos y fetales de Remifentanilo durante la cirugía cesárea. MÉTODOS: Dieciocho mujeres con embarazo de feto uno y con clasificación Asa I o II (sociedad americana de anestesiología) y que fueron sometidas a anestesia general para ces´rea semi eletiva, se dividieron aleatoriamente en dos grupos (40 mujeres en cada grupo) que recibieron un bolo intravenoso de 0.5 mm/Kg de remifentanil o en el grupo control la misma dosis de solución salina como placebo. Se evaluaron las variables hemodinámicas maternas y pH de la arteria umbilical neonatal y la puntuación de Apgar al primer y quinto minuto en ambos grupos. RESULTADOS: La presión arterial sistólica y diastólica fueron significativamente más bajos después de la intubación traqueal y la incisión de la piel en el grupo Remifentanilo en comparación con el grupo control (p <0.05). No hubo diferencias significativas en cuanto a la frecuencia cardíaca entre los grupos en cualquier tiempo (p> 0.05). Las puntuaciones de Apgar a los minutos primero y quinto no fueron significativamente diferentes entre los grupos (p> 0.05). No neonato requiere ventilación asistida o administración naloxan. CONCLUSIÓN: El Remifentanilo puede ser un fármaco seguro y eficaz para la inducción de la anestesia general y la estimulación quirúrgica sin depresión neonatal posterior.