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Query: UMLS:C0012833 (dizziness)
 9,689 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The efficacy and safety of prophylactic intravenous ondansetron in preventing postoperative nausea and vomiting was investigated in a randomized, stratified, double-blind, placebo-controlled, dose-comparison study of 580 ASA physical class I and II female outpatients undergoing gynaecological surgery and receiving general anaesthesia. Patients received either ondansetron 1, 4 or 8 mg, or placebo i.v. immediately prior to a standardized technique for induction and maintenance of anaesthesia. All patients were intubated and received nitrous oxide and a narcotic. All doses of ondansetron were significantly more effective than placebo in preventing emesis over the 24 h postoperative period. Ondansetron significantly decreased nausea and emesis scores over 24 h postoperatively without causing sedation. No changes in laboratory parameters (haematology, blood chemistry, and liver enzymes) or vital signs (heart rate, blood pressure, and respiratory rate) were observed. Headache and dizziness were the most common side-effects; however, their incidence was the same as with placebo. Ondansetron was generally well tolerated, as evidenced by an adverse event, laboratory safety, and vital sign profile similar to placebo. Ondansetron 4 mg was found to be the optimal prophylactic i.v. dose for female outpatients over the entire 24 h postoperative period. Higher doses may offer an added benefit in some patients, such as those with a history of nausea and vomiting following general anaesthesia.
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PMID:Prophylactic intravenous ondansetron in female outpatients undergoing gynaecological surgery: a multicentre dose-comparison study. 142 25

At the beginning, the way intrathecal morphine was used for postoperative pain relief was quite unfortunate, because the doses derived from experience with morphine-tolerant cancer patients were considerably too high and respiratory depression occurred frequently. Subsequent dose-finding studies showed that the doses of morphine used initially could be reduced by a factor of ten without loss of the analgesic effect and with a marked reduction in side-effects. No respiratory depression has been reported when doses below 0.1 mg morphine are used. METHOD. In this prospective study the effect of 0.06 to 0.08 mg intrathecal morphine, mixed with the local anaesthetic for spinal anesthesia, was investigated in surgical patients aged 21 to 81 years, ASA grade I or II, scheduled for orthopaedic operations or herniorraphies. Thirty unpremedicated patients were enrolled in the study and were, after informed consent, randomly allocated to a control group without morphine or to a morphine group. The analgesic effect was assessed by the time interval between the administration of the spinal anaesthesia and the first demand for an analgesic medication. The mood state was evaluated with the adjective checklist of Janke and Debus 6 h after the spinal anaesthesia. RESULTS AND DISCUSSION. In the control group half of the patients asked for an analgesic medication within 275 min (median) after the spinal anaesthesia, and all patients within 420 min, whereas in the morphine group half of the patients asked for an analgesic within 1170 min (median). Seven patients had not required an analgesic at the termination of the observation period 20 h after the spinal anaesthesia. The mood status showed no difference between the two groups, in particular, no dizziness or drowsiness after morphine. There was no difference in the incidence of side-effects such as nausea or urinary retention between the two groups. Pruritus was not reported spontaneously but was found upon questioning in five patients. It was in no case disturbing. CONCLUSIONS. Morphine (0.06 to 0.08 mg) mixed with the local anaesthetic for spinal anaesthesia provided for an analgesia of more than 20 h duration in half of the patients. This technique is safe, simple, reliable and virtually free of side-effects. No particular supervision due to the administration of intrathecal morphine is necessary in this dose range if systemic opiates are avoided. If the analgesia is unsatisfactory, a non-opioid analgesic is recommended.
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PMID:[Intrathecal morphine for postoperative pain]. 146 57

Propofol is associated with a low incidence of postoperative nausea and vomiting. In a prospective, randomized, double-blind, placebo-controlled study, we investigated the possible direct antiemetic properties of a subhypnotic dose of propofol. Fifty-two ASA physical status I or II patients, aged 15-60 yr with nausea and vomiting after minor gynecologic, orthopedic, or digestive tract surgery, were included in the study and received either propofol (10 mg = 1 mL) or placebo (1 mL Intralipid) intravenously in the postanesthesia care unit. Patients treated with propofol experienced a larger reduction in nausea and vomiting than patients treated with placebo (81% vs 35% success rate; P less than 0.05). Patients successfully treated had a similar incidence of relapse (propofol 28%; placebo 22%) within the first 30 min after therapy. Thirty-three percent of the propofol-treated patients and 44% of the placebo-treated patients showed a minor increase in sedation. The level of postoperative pain did not change in either group. Hemodynamic values remained unchanged in both groups. Pain on injection (7.6%) or dizziness (3.6%) only occurred in the propofol group. We conclude that propofol has significant direct antiemetic properties.
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PMID:Subhypnotic doses of propofol possess direct antiemetic properties. 831 40

Under study were thirty patients of ASA class I-II scheduled for lower abdominal and lower extremities surgery. Premedication included intramuscular injection of pethidine, atropine and prochlorperazine. Epidural anesthesia was accomplished with 12-15 ml 2% lidocaine with epinephrine (1:80,000). Thirty minutes later, when blood pressure returned to control value, patients were put to sleep by 2 mg/kg propofol and the sleep was maintained with continuous infusion of propofol at a rate of 6 mg/kg/h. Infusion rate was adjusted when necessary. Patients breathed room air spontaneously through the whole course of anesthesia. The results showed that all patients fell to sleep within 28.3 +/- 2.7 s after intravenous injection of propofol 2 mg/kg. Sleeping dose was satisfactorily achieved using a mean infusion rate of 6.1 +/- 1.7 mg/kg/h. The mean time from the end of the infusion of propofol to opening of the eyes on command and telling the correct date of birth were 7.9 +/- 2.8 min and 9.9 +/- 3.8 min respectively. Two minutes after injection, there were significant decrease in systolic pressure, diastolic pressure, cardiac output, and stroke volume with a mean of 17.9 +/- 3.8%, 18.8 +/- 3.3%, 7.6 +/- 0.5% and 11.1 +/- 1.9% respectively. Two patients (7%) developed apnea after 2 mg/kg propofol which was considered to be the most serious side effect. Propofol infusion had to be stopped in 13% patients due to a 30% fall of arterial blood pressure during maintenance. In the recovery stage, no other complications were noted except one patient who felt dizziness. Propofol, used as the supplementary sedative, provides satisfactory result for surgery under epidural anesthesia.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Intravenous propofol as a supplement in epidural anesthesia]. 175 43

The role of ambulatory electrocardiography for detection, confirmation, or exclusion of severe forms of arrhythmias was investigated in our preoperative anesthesia clinic. In a prospective study over a period of 21 months, 30 of 8935 preoperatively evaluated patients (0.3%) scheduled for noncardiac surgery were monitored by 24-h ambulatory ECG. Indications included common clinical reasons for ordering an ambulatory ECG and additional specific "anesthesiologic" indications: Syncopes, dizziness, or other manifestations possibly related to cardiac arrhythmias; Rhythm disturbances under antiarrhythmic drug therapy; Suspected paroxysms of supraventricular tachycardia; Q-T syndrome, R- on-T phenomenon; Insignificant rhythm disturbances in patients with significant cardiac disease such as cardiomyopathy, aortic stenosis, mitral valve prolapse; Rhythm disturbances in patients with poor general medical status; Recent myocarditis with arrhythmias; Previous known or suspected intraoperative cardiac complications; Suspected sick sinus syndrome. The mean age of the patients was 63.9 years; most (24/30) were classified as ASA III. In 4 patients with suspected bradycardic rhythm disturbances the ambulatory ECG proved a useful method for further decision-making compared to the routine resting ECG. According to the long-term ECG recordings 22 patients were classified as Lown IV. After effective antiarrhythmic therapy--usually with propafenon--none of these patients (n = 13) or those classified as Lown 0 to III (n = 8) showed intraoperative arrhythmias or other hemodynamic problems. In contrast, of the patients with complex rhythm disturbances refractory to antiarrhythmic drug therapy (n = 4) or those in whom emergency operations were performed without antiarrhythmic drug therapy (n = 2), 4 developed severe arrhythmias or other intraoperative hemodynamic problems. Two died on the 1st postoperative day.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Preoperative risk assessment: long-term electrocardiography for directed diagnosis of arrhythmias]. 231 6

The frequency of postanesthesia side effects and times to reach "benchmarks" in the recovery process for IV preinduction doses of 20 micrograms/kg butorphanol, 40 micrograms/kg butorphanol, or a 2 micrograms/kg dose of fentanyl were compared in a double-blinded study involving ambulatory surgical patients. The authors hypothesized that all drugs would perform equally well in all study areas. Sixty ASA physical status I and II women undergoing laparoscopic tubal sterilization were randomly assigned to one of three groups: Group I (n = 20) received 20 micrograms/kg butorphanol as a preinduction agent; Group II (n = 20) received 40 micrograms/kg butorphanol; Group III (n = 20) received 2 micrograms/kg fentanyl. Anesthesia management for all groups was the same. Statistically significant variance was found in time to discharge-ready status and duration of nausea (p less than 0.05) between 40 micrograms/kg butorphanol and 2 micrograms/kg fentanyl, but no significant difference was found between 20 micrograms/kg butorphanol and 2 micrograms/kg fentanyl in these areas. Statistically significant variance was found in duration of dizziness and time to obtain a 10 on the Aldrete Post Anesthesia Recovery Score (APARS) between 40 micrograms/kg butorphanol and 20 micrograms/kg butorphanol and 40 micrograms/kg butorphanol and 2 micrograms/kg fentanyl. From the study, 20 micrograms/kg butorphanol appears to be as suitable as 2 micrograms/kg fentanyl for use as a preinduction narcotic analgesic, whereas 40 micrograms/kg butorphanol appears to be unsuitable due to increased duration of nausea, dizziness, and time to score 10 on APARS and reach discharge-ready status.
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PMID:A comparison of recovery in outpatients receiving fentanyl versus those receiving butorphanol. 262 7

A randomized, prospective, comparative study was performed to evaluate induction characteristics, haemodynamic changes and recovery in 60 ASA I-II patients undergoing mainly gynaecological laparotomies with either propofol or thiopentone-enflurane anaesthesia. The propofol group (n = 30) received 2 mg.kg-1 propofol for induction of anaesthesia followed by propofol infusion. The thiopentone-enflurane group (n = 30) received thiopentone 4 mg.kg-1 for induction followed by enflurane (0.5-2 per cent). All patients received nitrous oxide (66 per cent] in oxygen begun one minute after tracheal intubation, and fentanyl (1.5 micrograms.kg-1) four minutes prior to induction. Other drugs administered during or after anaesthesia were similar among the groups. Haemodynamic measurements were similar between propofol and enflurane groups except after tracheal intubation when the mean arterial pressure was lower in the propofol group (P less than 0.05). The propofol group had significantly less (P less than 0.01) emesis in the recovery room than the enflurane group. The propofol group experienced significantly less (P less than 0.05) dizziness, depression/sadness and hunger than the enflurane group in the postoperative period as assessed with a visual analogue questionnaire. We conclude that propofol provided better outcome than enflurane in terms of these nonvital but annoying outcome measures after relatively long intra-abdominal operations.
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PMID:Randomized comparison of outcome after propofol-nitrous oxide or enflurane-nitrous oxide anaesthesia in operations of long duration. 268 41

Twelve rheumatic patients were given 2.0 and 4.5 g acetylsalicylic acid daily in two 3-week periods. On days 13 and 20 of each period the patients took a suppository containing either placebo or 50 mg of indomethacin. The study was performed double-blind. Indomethacin had a significant additive effect during ASA therapy with 2 g daily as estimated by articular index and subjective ratings of pain and morning stiffness. On the 4.5 g ASA dose there was a significant improvement only for articular index. The patients experienced less pain during maintenance therapy with 4.5 g of ASA compared with 2.0 g daily. Both ASA doses induced complete inhibition of prostaglandin PGF2 alpha release from platelets. Thus the suppression of PGF2 alpha release does not reflect the therapeutic response of these drugs. Side effects observed comprised tinnitus, dizziness and gastritis. In 2 of the patients the aminotransferase levels increased, indicating hepatotoxicity. The protein binding of salicylate decreased with increasing salicylate concentration. As the dose was increased from 2.0 to 4.5 g/day the unbound concentration increased 5 to 24 times. This reflects the combined effect of capacity-limited metabolism and capacity-limited protein binding of salicylate.
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PMID:Additive clinical effect of indomethacin suppositories during salicylate therapy in rheumatoid patients. 701 17

Forty-five ASA physical status I volunteers, divided in three groups of 15 each, received intravenous regional anesthesia (IVRA) of the upper limb with 40 mL meperidine 0.25%, lidocaine 0.5%, or 0.9% sodium chloride (isolated ischemia) by random allocation. Using a double-blind method, the onset and recovery of sensory block was tested at six sites of the forearm and hand. The onset of complete motor block was also assessed. The symptoms after deflation of the tourniquet were recorded. The onset of block, as determined by pin-prick touch, and cold was significantly faster in the meperidine group (P < 0.001) than in the saline group, but also slower (P < 0.001) than in the lidocaine group. After the tourniquet was deflated, recovery occurred in reverse order. A complete motor block was noted in all volunteers from the meperidine and lidocaine groups, but in only 11 cases from the 0.9% sodium chloride group (P < 0.01). In the meperidine group, motor block developed concomitantly or prior to sensory block. There was a significant increase in the incidence of dizziness, nausea, and pain at the injection site in the meperidine group in comparison with the lidocaine group. We conclude that meperidine has local anesthetic action on the peripheral nerve in vivo, but that its single use for IVRA should be a second choice for patients allergic to local anesthetics.
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PMID:Intravenous regional anesthesia with meperidine. 953 32

This study investigated the impact of perioperative fluid status on adverse clinical outcomes in ambulatory surgery. Two hundred ASA grade I-III ambulatory surgical patients were prospectively randomized into two groups to receive high (20 mL/kg) or low (2 mL/kg) infusions of isotonic electrolyte solution over 30 min preoperatively. A standardized balanced anesthetic was used. A minimal amount of fluid was given during the intraoperative and postoperative periods. Adverse outcomes were assessed by an investigator blinded to the fluid treatment group at 30 and 60 min after surgery, at discharge, and the first postoperative day. The incidence of thirst, drowsiness, and dizziness was significantly lower in the high-infusion group at all intervals. We recommend perioperative hydration of 20 mL/kg for patients undergoing general anesthesia for short ambulatory surgery.
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PMID:A prospective randomized double-blinded study of the effect of intravenous fluid therapy on adverse outcomes on outpatient surgery. 748 33


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