Association between preoperative maternal anxiety and neonatal outcomes: a prospective observational study.

STUDY OBJECTIVE: Preoperative anxiety can be associated with poor postoperative clinical outcomes. We aimed to assess whether preoperative maternal anxiety level of obstetric patients scheduled for elective cesarean surgery has an effect on clinical outcome of the newborn. DESIGN: A prospective observational study. SETTING: Operating room. PATIENTS: Sixty pregnant women with American Society of Anesthesiologists physical status 1 and 2 scheduled for elective cesarean surgery were enrolled. INTERVENTIONS: All patients received spinal anesthesia with hyperbaric bupivacaine 12.5mg. MEASUREMENTS: We performed a State-Trait Anxiety Inventory questionnaire to evaluate preoperative maternal anxiety. We used the Apgar scoring system to assess the physical condition of the newborn. Hemodynamic measurements (heart rate, systolic and diastolic blood pressure) were recorded at baseline, skin incision, childbirth, and 10, 15, and 30minutes after skin incision. The use of ephedrine, nausea, and vomiting were recorded as well. MAIN RESULTS: Average preoperative maternal state anxiety score was 41.1±4.6, and trait anxiety score was 50.9±5.7. Average Apgar scores of newborns were 7.6±0.8 and 9.2±0.6, at first minute and fifth minute, respectively. We found no significant relationship between the anxiety scores and Apgar scores at first and fifth minute. Forty-two patients required ephedrine, 5 patients had nausea, and 5 patients had vomiting. CONCLUSIONS: We concluded that there was no relationship between preoperative maternal anxiety scores and Apgar scores at the first and fifth minute.

Comparison of the effect of adding remifentanil to patient-controlled tramadol or morphine for postoperative analgesia after major abdominal surgery.

OBJECTIVE: In this study, the authors investigated the effect of the addition of remifentanil to tramadol or morphine for patient-controlled analgesia (PCA). DESIGN: Prospective, randomized, double-blind, controlled study. SETTING: University Hospital. PATIENTS, PARTICIPANTS: The authors randomly allocated 133 patients undergoing major abdominal surgery to receive IV PCA with tramadol alone, tramadol plus remifentanil, morphine alone or morphine plus remifentanil. INTERVENTIONS: Bolus doses of tramadol (0.2 mg/kg), tramadol (0.2 mg/kg) plus remifentanil (0.2 microg/kg), morphine (0.02 mg/kg), or morphine (0.02 mg/kg) plus remifentanil (0.2 microg/kg) were available every 10 minutes without time limit or background infusion. MAIN OUTCOME MEASURE(S): Discomfort, sedation, pain scores, side effects, and total and bolus tramadol and morphine consumption were recorded for up to 24 hours after the start of PCA. RESULTS: Pain scores at rest and movement were greater with tramadol alone than in the other groups at 1, 2, and 6 hours (p < 0.0125). The addition of remifentanil reduced cumulative tramadol consumption at 6, 12, and 24 hours, but not morphine consumption. More patients required supplementary rescue analgesia with meperidine, and with greater dosage, with tramadol alone (p < 0.001), and the incidence of nausea was greater with tramadol alone. The addition of remifentanil not only significantly improved discomfort scores in remifentanil groups, but also increased the degree of sedation in morphine-remifentanil group. CONCLUSIONS: After major abdominal surgery, adding remifentanil to PCA tramadol resulted in better pain scores, lower analgesic consumption, and fewer side effects when compared with tramadol alone. However, analgesic outcome with remifentanil was not prominent in MR group as much as in TR group.

A comparative study of the analgesic effect of patient-controlled morphine, pethidine, and tramadol for postoperative pain management after abdominal hysterectomy.

We designed this prospective, randomized, double-blind study to compare the analgesic effectiveness and side effects of IV patient-controlled morphine, pethidine, and tramadol for postoperative pain management. One-hundred-twenty-six ASA physical status I or II patients undergoing abdominal hysterectomy were randomly allocated to receive IV-patient controlled morphine (M), pethidine (P), or tramadol (T) for postoperative analgesia. The cumulative analgesic consumption over 24 h was 25.7 +/- 9.5 mg for morphine, 266 +/- 90 mg for pethidine, and 320 +/- 10 mg for tramadol. The average supplementary fentanyl dose used was significantly higher in group T than in groups M and P (P < 0.05). In conclusion, morphine, pethidine, and tramadol resulted in equivalent pain scores and side effects, but tramadol group T required more rescue analgesic doses of fentanyl.