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Query: UMLS:C0027497 (nausea)
 23,468 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Three anesthetic techniques were compared in this study: 1) Intermittent Brevital boluses supplemented with fentanyl and midazolam all titrated to patient movement, 2) constant infusion of Brevital supplemented with fentanyl and midazolam all delivered in calculated mg/kg doses based on total body weight, and 3) constant infusion of methohexital (Brevital) and alfentanil (Alfenta) supplemented by midazolam (Versed), droperidol, and glycopyrolate (Robinul) delivered in calculated mg/kg doses based on lean body mass. Nitrous oxide was delivered in all cases via nasal mask in a 30% to 50% concentration. The mean total dose of Brevital in group 1 (intermittent Brevital bolus) was 0.17 mg/kg/min (SD = 0.07), group 2 (Brevital infusion) was 0.23 mg/kg/min (SD = 0.06), and group 3 (alfentanil/Brevital infusion) was 0.12 mg/kg/min (SD = 0.07). Mean total dose of alfentanil in group 3 equaled 1.58 mcg/kg/min (SD = 0.73). In group 1, 94% of the patients experienced moderate to severe movement intraoperatively. Twenty-three percent of the patients in group 2, and only 7% of group 3 exhibited moderate to severe movement. Emergence in group 3 averaged 4.5 minutes (SD = 1.6). Three patients (7%) in group 3 had postoperative nausea. Additional subjective findings in group 3 included easier airway maintenance during administration of the anesthetic, lack of unpleasant emergence phenomena such as crying, and prompt readiness for discharge. It was concluded that continuous alfentanil and Brevital infusion satisfied the objectives of safety, stability, predictability, and rapid recovery, while improving operating conditions (less patient movement) when compared with more traditional anesthetic techniques.
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PMID:Continuous infusion of methohexital and alfentanil hydrochloride for general anesthesia in outpatient third molar surgery. 249 19

The objective of this study was to present data supporting the effectiveness of performing mini and full abdominoplasties under conscious sedation with local anesthesia. The authors performed 20 such operations between 1994 and 1996, using a combination of midazolam (Versed) and fentanyl instead of general anesthesia (without an anesthesiologist or nurse anesthetist present). At 5- to 10-minute intervals, the surgeon would order the injection of 1 cc (1 mg/ml) of midazolam and 1 cc (50 microg/ml) of fentanyl. The amount and the interval varied based on the patient's level of sedation. Blood pressure, oxygen saturation, and the patient's response to verbal and physical stimuli were used to assess the sedation level. Average operating time was 147.5 minutes, and mean length of stay in the outpatient recovery room was 235.5 minutes. The average amounts of midazolam and fentanyl used were 9.4 mg (6 to 12.5 mg) and 532 microg (300 to 800 microg), respectively. The average age of patients in this group was 41.7 years (28 to 63 years). Nineteen patients were discharged the same day. There were no surgical complications and no complication related to the sedation (such as respiratory or cardiac compromise). The average follow-up of these patients was 1.2 years (range, 3 to 21 months). Correlation coefficient rates and regression rates were calculated. The longer the procedure, the more midazolam was used intraoperatively (r = 0.5, p = 0.03). However, there was no correlation between the length of the procedure and the amount of fentanyl used. Rather, there was a positive correlation demonstrating that patients who received more fentanyl stayed longer in the outpatient recovery area after surgery (r = 0.6, p < 0.01). The age of the patients and the amount of midazolam did not correlate with how fast they went home from the outpatient area. In conclusion, full and mini abdominoplasties can be performed safely using conscious sedation without compromising patient care or surgical outcome. Second, the survey revealed that patient satisfaction with these procedures performed under conscious sedation was very high. Third, the increased use of fentanyl, not midazolam, resulted in a longer stay in the outpatient unit after surgery. Nausea is a known side effect of narcotic analgesics, and it correlated with a higher dose of fentanyl administration in the patients. The authors are now routinely administering a dose of either droperidol or odansetron (Zofran) preoperatively (both are antiemetics). Previously, the ratio of midazolam and fentanyl injection was 1:1 every 5 to 10 minutes, but now it is 2: 1 to 4: 1 every 5 to 10 minutes (a smaller dose of fentanyl is administered). The conscious sedation technique should be an option for patients and plastic surgeons in academic and community hospital settings if they desire.
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PMID:The clinical outcome of abdominoplasty performed under conscious sedation: increased use of fentanyl correlated with longer stay in outpatient unit. 1114 10