[The Analgesic Sparing Effect of Ketamine for Postoperative Pain Management after Pediatric Surgery on the Body Surface].

BACKGROUND: It is reported that ketamine, a N-methyl-D-aspertate (NMDA) receptor antagonist, can provide analgesic effect improving postoperative pain management and decrease the supplementary analgesic requirement. We investigated the analgesic sparing effect of ketamine for postoperative pain in children undergoing surgery of body surface. METHODS: Fifty eight patients (0-9 yrs) who had surgery of body surface were divided into two groups (ketamine : n = 27, Group K or control : n = 31, Group N). Postoperative analgesia extracted from charts was retrospectively evaluated by the times patients used analgesics until discharge after the operations. Chi-square and Mann-Whitney U tests were used for statistical analysis. Results : The ketamine group received an intrave- nous bolus of ketamine (1 mg - kg-1) before surgical skin incision. However, there were no significant differ- ences of usage (Group K vs Group N : 4/27 vs 7/31, P=0.45) and frequency of supplementary analgesic us- ages (P=0.85) among groups. In addition, there were also no significant demographic differences between the two groups. Conclusions : Our investigation suggests that the intravenous bolus of ketamine (1 mg - kg-1) before surgical skin incision does not decrease the supple- mentary analgesic requirements on postoperative pain management in pediatric surgery of the body surface.

[The Influence of Flurbiprofen on the Frequency of Postoperative Shivering].

BACKGROUND: Many methods to prevent postoperative shivering (POS) has been reported. However, there are few reports demonstrating the effect of flurbiprofen on POS which affects the set point in the thermocenter of the hypothalamus. METHODS: One hundred and forty six patients undergoing lung lobectomy or segmentectomy under video-assisted thoracic surgery were divided into a flurbiprofen-treated group (Group F) and a non-treated group (Group N). We retrospectively investigated the incidence of POS associated with total intravenous anesthesia with epidural anesthesia compared with or without flurbiprofen. We weighed the incidence of POS against age, body mass index, the effective site concentration of fentanyl on extubation, the mean dose of remifentanil, the minimum rectal temperature, the surgical duration and total hemorrhage volume based on the anesthetic chart Chi-square and Student t-test were used for statistical analysis. RESULTS: Although the surgical duration in Group F was shorter than that in Group N (223±83 vs. 165±80 (min), P<0.01), the incidence of POS in Group F was higher than that in Group N (1/32 vs. 28/114, P<0.01). There were no significant differences in another items between the two groups. CONCLUSIONS: The results of the study indicates that flurbiprofen has a possible beneficial effect in preventing POS.

[Efficacy of oral balance gel for dry mouth in preoperative patients].

BACKGROUND: Following anticholinergic premedication and preoperative fasting, preoperative patients with a potential xerostomia have complaints associated with oral dryness. Xerostomia may lead to risk of mucosal burning and secondary infection. The purpose of this prospective study was to assess the effect of oral balance gel on dryness of the mouth in preoperative patients. METHODS: Thirty nine patients scheduled for elective surgery were randomly assigned to either of the group with or without using the oral balance gel. Severity of the dry mouth was assesed using a 4-point scale (0=none, 1=mild, 2=moderate, 3=severe) and diadochokinesis test was performed on the day before surgery and on arrival at the OR. RESULTS: Comparing results of the two stages, we found that patients with no treatment had significantly deteriorated state of dry mouth, but patients who had received the oral balance gel had no significantly worse dry mouth compared with the preoperative state. CONCLUSIONS: In this study, patients without the oral balance gel frequently reported oral symptons and oral dysfunction associated with xerostomia. We conclude that the use of oral balance gel in preoperative patients is effective for the prevention of dryness of the dry mouth.

Lack of opiate effects on cat C polymodal nociceptive fibers.

The direct application of preservative-free morphine sulfate (1.5%, 1 ml, 19.8 mumol) or fentanyl (0.06%, 1 ml, 1.07 mumol) on the superficial radial or saphenous nerve of cats did not alter the response of single C polymodal nociceptive fibers (PMNs) to noxious radiant heat stimulation of their peripheral receptive fields. Intravenous administration of fentanyl (100 or 200 micrograms/kg, 0.179 or 0.358 mumol/kg) also showed a similar lack of effect on the radiant heat evoked responses of single PMNs. Slight changes in the mean latencies following drug administration were recognized, which were not statistically significant. The use of morphine (1.5%, 1 ml, 19.8 mumol) with preservatives (chlorbutanol 0.5% and sodium bisulfite less than 0.1%) caused conduction block of PMNs within 6-15 min. Subsequent washout of the drug resulted in the return of the unitary discharges within 8 min. Lidocaine (0.25 and 0.5%, 10.7 mumol and 21.4 mumol) caused conduction block within 5-18 min. These data support the classically held concept that opiates, in clinically useful concentrations, do not alter peripheral nerve function.