Asian journal of anesthesiology最新文献

{"title":"Ultrasound Guidance for Internal Jugular Vein Catheterization: Don't Forget the Basics.","authors":"M. Fromentin, M. Barat, J. Ricard, D. Roux","doi":"10.6859/aja.202203_60(1).0006","DOIUrl":"https://doi.org/10.6859/aja.202203_60(1).0006","url":null,"abstract":"Internal jugular vein (IJV) cannulation is a stan-dard procedure for critically ill patients that should be performed under ultrasound (US) guidance. The use of two-dimensional US was found to decrease the risk of total adverse events by 71% in a recent review that included 35 studies and 5,108 participants. 1 Major complications such as hemothorax, mediastinal hematoma, cardiac tamponade, or chylothorax. 2 Accidental arterial puncture and hematoma are the two most re-duced complications by pre-procedure US location of vessels. 1 Several techniques with their specific complications are described. Common the most","PeriodicalId":8482,"journal":{"name":"Asian journal of anesthesiology","volume":"60 1 1","pages":"41-42"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45634316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Study of Efficacy of Buprenorphine and Fentanyl on Attenuation of Hemodynamic Changes to Laryngoscopy and Intubation: A Prospective, Randomized Double-Blind Study.","authors":"Vikas Kumar, Sanjeev Kumar, A. Bharti, R. Avinash, K. H. Raghwendra","doi":"10.6859/aja.202203_60(1).0004","DOIUrl":"https://doi.org/10.6859/aja.202203_60(1).0004","url":null,"abstract":"BACKGROUND\u0000Hemodynamic changes are the most common predicted response after laryngoscopy and intubation during general anesthesia. We compared the efficacy of buprenorphine with fentanyl to attenuate this stress response.\u0000\u0000\u0000METHODS\u0000One hundred and thirty patients of either sex between the age group of 18-70 years, admitted for the routine surgical procedure under general anesthesia were enrolled in this double blind, randomized, clinical study. Patients were randomly assigned into two equal groups (60 patients in each group): group F received fentanyl 2 μg/kg, and group B received buprenorphine 2.5 μg/kg; both via intravenous route. Each group received a total volume of 10 mL by adding normal saline to the total drug volume, given over 60 seconds, 5 minutes before intubation. Thereafter patients were induced using routine balanced anesthesia technique, and the hemodynamic parameters were observed at baseline (0 minute), 1, 3, and 5 minutes after the administration of the study drug and again at 1, 3, 5, 7, and 10 minutes after intubation. Continuous variables were presented as mean with an 80% confidence interval, and a t-test was applied for comparing the difference of means between two groups after we checked the normality condition. Chi-square test was applied to test the independence of attributes of categorical variables. Repeated measures two-way analysis of variance was performed to compare the outcome variables between the two groups.\u0000\u0000\u0000RESULTS\u0000In both groups, mean arterial blood pressure (MAP) and heart rate (HR) were statistically insignificant up to 5 minutes after study drug, thereafter mean HR and MAP at 1, 3, 5, 7, and 10 minutes after intubation, were statistically significant between the two groups, and P value was less than 0.05.\u0000\u0000\u0000CONCLUSIONS\u0000The dose of 2.5 μg/kg buprenorphine is an effective alternative to fentanyl 2 μg/kg for attenuating the hemodynamic response accompanying laryngoscopy and tracheal intubation without causing any hemodynamic adverse effect.","PeriodicalId":8482,"journal":{"name":"Asian journal of anesthesiology","volume":"60 1 1","pages":"26-32"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47032581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Hemodynamics and Opioid Sparing Effect of Dexmedetomidine Nebulization and Intravenous Dexmedetomidine in Laparoscopic Surgeries Under General Anesthesia.","authors":"Kantharaju Shankar, S. Rangalakshmi, P. Kailash, D. Priyanka","doi":"10.6859/aja.202203_60(1).0005","DOIUrl":"https://doi.org/10.6859/aja.202203_60(1).0005","url":null,"abstract":"BACKGROUND\u0000Dexmedetomidine has been used by multiple routes in laparoscopic surgeries to attenuate the hemodynamic response. The present study was done to compare the efficacy of dexmedetomidine nebulization with intravenous dexmedetomidine and fentanyl in laparoscopic surgeries under general anesthesia.\u0000\u0000\u0000METHODS\u0000A prospective, double blind study was conducted, and 90 American Society of Anesthesiologists (ASA) I and II patients of either gender between 18-65 years undergoing laparoscopic surgeries under general anesthesia were randomized into three groups. (1) Group N (n = 30) received dexmedetomidine nebulization 1 mcg/kg in 3 mL of 0.9% saline 15 minutes before induction and 10 mL of intravenous 0.9% saline over 10 minutes at the time of induction of anesthesia. (2) Group I (n = 30) received 0.9% saline nebulization 3 mL and intravenous dexmedetomidine 1 mcg/kg in 10 mL of 0.9% saline. (3) Group F (n = 30) received 0.9% saline nebulization 3 mL and intravenous fentanyl 2 mcg/kg in 10mL of 0.9% saline. Heart rate, blood pressure, propofol requirement, and opioid consumption were monitored throughout surgery and for 1 hour in post-operative period. Statistical analysis was done by using analysis of variance test, chi-square test. P value ＜ 0.05 was considered signifi cant.\u0000\u0000\u0000RESULTS\u0000Suppression of hemodynamic response following intubation and pneumoperitoneum by dexmedetomidine nebulization was compared to intravenous dexmedetomidine and fentanyl. Opioid requirement was significantly lower in dexmedetomidine group than fentanyl group (P ＜ 0.05). Propofol requirement was lower with intravenous and nebulized dexmedetomidine than intravenous fentanyl.\u0000\u0000\u0000CONCLUSIONS\u0000In laparoscopic surgeries, nebulized dexmedetomidine suppresses hemodynamic response when compared to intravenous dexmedetomidine along with dose sparing effect of opioid and propofol.","PeriodicalId":8482,"journal":{"name":"Asian journal of anesthesiology","volume":"60 1 1","pages":"33-40"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46420100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Comparison Between Supreme Laryngeal Mask Airway and Endotracheal Tube With Respect to Adequacy of Ventilation in Patients Undergoing Laparoscopic Cholecystectomy Under General Anesthesia-A Prospective, Randomized, Double-Blind Study, and Comparative Study.","authors":"Deepak B Bhushan, S. Nandkumar, Manju Butani","doi":"10.6859/aja.202202/PP.0001","DOIUrl":"https://doi.org/10.6859/aja.202202/PP.0001","url":null,"abstract":"BACKGROUND\u0000Laparoscopic cholecystectomy is a commonly performed surgical procedure. Most anesthesiologists advocate tracheal intubation. Laparoscopic cholecystectomy is becoming a day care surgery, hence many anaesthesiologists have started using laryngeal masks to decrease airway manipulation seen with conventional laryngoscopy and endotracheal intubation and avoid hemodynamic pressor responses and postoperative sore throat. The Supreme laryngeal mask airway (LMA) is an innovative, sterile, single use, supraglottic airway management device which provides access to and functional separation of the respiratory and digestive tracts. In this study, there are two objectives-(1) primary objective: to assess the adequacy of ventilation when using LMA-Supreme^(TM) (LMA-S) and endotracheal tube (ETT), and (2) secondary objective: the first is to give the time for achieving effective airway and number of attempts for securing airway. The second is to assess haemodynamic parameters (heart rate and blood pressure). The last is to show the incidence of gastric distension, regurgitation and postoperative sore throat.\u0000\u0000\u0000METHODS\u0000A total of 132 American Society of Anesthesiologists (ASA) I-II patients were randomly assigned to LMA-S and ETT for intraoperative ventilation. After induction of general anaesthesia, the device was inserted, correct placement was checked, and parameters were recorded. SPSS version 20.0 software (IBM Corp., Armonk, NY, USA) was used for statistical analysis. A P-value less than 0.05 is statistically significant.\u0000\u0000\u0000RESULTS\u0000Ventilatory parameters such as inspiratory and expiratory leak volumes, and peak airway pressure values were comparable between the groups throughout the entire time interval. The number of attempts for successful insertion were comparable, but the mean time required for achieving effective airway was significantly longer in ETT than LMA-S (25.2 ± 8.3 sec vs. 18.6 ± 5.1 sec, respectively [P ＜ 0.05]). There was no situation in which the patient from the LMA-S group had to be intubated. The haemodynamic responses to insertion, pneumoperitoneum inflation and deflation, and removal of the device were greater for the ETT than the LMA-S. There were no complications like gastric distension or regurgitation in either groups. The postoperative sore throat at 2 hours and 24 hours was significantly lower in group LMA-S than group ETT.\u0000\u0000\u0000CONCLUSIONS\u0000Positive pressure ventilation with a correctly placed LMA-S allows adequate pulmonary ventilation, without the untoward hemodynamic and postoperative adverse effects of endotracheal intubation, in laparoscopic cholecystectomy surgery.","PeriodicalId":8482,"journal":{"name":"Asian journal of anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47110255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Dexmedetomidine as an Adjuvant to Ropivacaine in Transversus Abdominis Plane Block for Postoperative Analgesia in Unilateral Infraumbilical Surgeries-A Randomized Prospective Trial.","authors":"K. Gupta, Bhabesh Prasad Panda, Gurpreet Singh, Amanjot Singh","doi":"10.6859/aja.202202/PP.0002","DOIUrl":"https://doi.org/10.6859/aja.202202/PP.0002","url":null,"abstract":"BACKGROUND\u0000Transversus abdominis plane (TAP) block has been demonstrated to be an effective module of multimodal analgesic treatments for infra-umbilical surgeries with limited duration of action. Various adjuvants have been studied to increase the efficacy of this technique. Herein, we evaluated the analgesic efficacy of dexmedetomidine with ropivacaine in TAP block for unilateral infra-umbilical surgeries under spinal anesthesia.\u0000\u0000\u0000METHODS\u0000The study was conducted on 60 adult patients with the age of 18-65 years, who were planned for unilateral infra-umbilical surgeries under spinal anesthesia. These patients are randomly divided into 2 groups (30 each). In group A, 20 mL of 0.25% ropivacaine with 1 mL of normal saline, and in group B, 20 mL of 0.25% ropivacaine with 0.5 μg/kg (1 mL) dexmedetomidine was given in ultrasound-guided TAP block. Duration, quality of analgesia, and total analgesic consumption were noted. Statistical analysis was performed with SPSS software version 21.0 (IBM Corp., Armonk, NY, USA) by using Student's t-test and chi-square test.\u0000\u0000\u0000RESULTS\u0000The mean duration of analgesia was significantly longer in group B than group A (842.50 ± 38.74 min and 435.17 ± 25.75 min, respectively). Verbal numerical rating scale was persistently low in both groups, except at the 7th hour and 20th hour in group A and the 12th hour in group B. Total analgesic consumption and number of analgesics doses during 24 hours after surgery were also lower in group B.\u0000\u0000\u0000CONCLUSIONS\u0000The addition of dexmedetomidine as adjuvant to 0.25% ropivacaine for TAP block significantly increases the duration and quality of analgesia without any significant adverse effects.","PeriodicalId":8482,"journal":{"name":"Asian journal of anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45063366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Radiofrequency and Corticosteroid Injection for Treatment of Lumbar Facet Joint Pain: A Meta-Analysis.","authors":"A. Wardhana, R. Ikawaty, H. Sudono","doi":"10.6859/aja.202202/PP.0003","DOIUrl":"https://doi.org/10.6859/aja.202202/PP.0003","url":null,"abstract":"BACKGROUND\u0000Lumbar facet joint (LFJ) pain was reported to occur in 27%-40% of patients with chronic low back pain (LBP). Several therapeutic procedures such as corticosteroid injection (CI) and radiofrequency (RF) ablation have been used. However, there is no clear consensus that one is superior to the other. This study aimed to perform a meta-analysis to compare the effectiveness of CI and RF ablation for LFJ pain.\u0000\u0000\u0000METHODS\u0000This study was conducted by searching for all randomized controlled trials comparing the effect of CI and RF ablation on LFJ pain in Cochrane Central Register of Controlled Trials and PubMed database. We performed inverse-variance weighted meta-analysis of outcomes including pain intensity and functional disability at 3, 6, and 12-month measurement by using RevMan 5.3 (Cochrane, London, England).\u0000\u0000\u0000RESULTS\u0000CI was associated with a higher pain intensity score when compared to RF ablation at 3 months (3 trials; standardized mean difference [SMD], 1.09; 95% CI, 0.79 to 1.38; P ＜ 0.00001; I^2 = 96%), at 6 months (7 trials; SMD, 2.10; 95% CI, 0.98 to 3.22; P = 0.00002; I^2 = 96%), and at 12 months (3 trials; SMD, 2.15; 95% CI, -0.26 to 4.56; P = 0.08; I^2 = 98%). The estimated effect of CI on functional disability score at 6 months when CI was compared to RF ablation showed a significant increase (3 trials; MD, 18.78; 95% CI, 16.20 to 21.36; P ＜ 0.00001; I^2 = 98%).\u0000\u0000\u0000CONCLUSIONS\u0000Pooled analysis from limited trials showed a benefit of RF to the improvement of pain intensity and functional disability when we compared RF with CI for the treatment of LFJ pain.","PeriodicalId":8482,"journal":{"name":"Asian journal of anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42601736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Submental Intubation in Patients With Complex Facial Bone Fractures.","authors":"Yung-Lin Hsieh, Po-Chih Hsu, Cay-Huyen Chen, Ming-Chang Kao","doi":"10.6859/aja.202112_59(4).0007","DOIUrl":"https://doi.org/10.6859/aja.202112_59(4).0007","url":null,"abstract":"","PeriodicalId":8482,"journal":{"name":"Asian journal of anesthesiology","volume":"59 4","pages":"174-175"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39393032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Total Intravenous Anesthesia Versus Inhalation Anesthesia on Postoperative Analgesia and Nausea and Vomiting After Bariatric Surgery: A Systematic Review and Meta-Analysis.","authors":"Muhammad M Ahmed,&nbsp;Chenchen Tian,&nbsp;Justin Lu,&nbsp;Yung Lee","doi":"10.6859/aja.202112_59(4).0002","DOIUrl":"https://doi.org/10.6859/aja.202112_59(4).0002","url":null,"abstract":"<p><p>Anesthesia for patients with morbid obesity can be challenging because of increased risk of opioid-related adverse events, postoperative nausea and vomiting (PONV), and poor pain control. We conducted a systematic review and meta-analysis to compare the safety and efficacy of total intravenous anesthesia (TIVA) with inhalation anesthesia in patients undergoing bariatric surgery. We searched MEDLINE, EMBASE, CENTRAL, and the Clinical Trials Registry database from inception to July 22, 2020. Primary outcomes were postoperative pain and PONV scores. Secondary outcomes included opioid requirements, intraoperative time, complications, and time to recovery. Grading of Recommendations Assessment, Development, and Evaluation framework was used to rate the certainty of evidence. Among 722 studies identified in our search, 7 randomized studies involving a total of 682 patients met the inclusion criteria. Bariatric surgery with TIVA resulted in a lower incidence of nausea (relative risk [RR], 0.54; 95% CI, 0.31-0.94; P = 0.03; moderate certainty) and vomiting (RR, 0.31; 95% CI, 0.13-0.74; P = 0.008; moderate certainty). There was no difference in postoperative pain at 30 minutes, 1 hour, or 24 hours, or in postoperative opioid requirements. Patients undergoing bariatric surgery with TIVA had significantly lower incidence of PONV but no difference in postoperative pain when TIVA was compared to inhalation anesthesia techniques. These benefits should be considered in order to improve the quality of care and enhance recovery for the bariatric population, who are at an increased baseline risk of perioperative complications. Future adequately powered randomized controlled trials are needed to compare the efficacy of the anesthesia regimens in patients undergoing bariatric surgery.</p>","PeriodicalId":8482,"journal":{"name":"Asian journal of anesthesiology","volume":"59 4","pages":"135-151"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39798580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Randomized, Active-Controlled, Parallel-Group Clinical Study Assessing the Efficacy and Safety of FKScope® for Nasotracheal Intubation in Patients Scheduled for Oral and Maxillofacial Surgery Under General Anesthesia.","authors":"Yu-Chi Huang,&nbsp;Shu-Yu Ou,&nbsp;Yu-Ting Kuo,&nbsp;Yuan-Yi Chia","doi":"10.6859/aja.202112_59(4).0003","DOIUrl":"https://doi.org/10.6859/aja.202112_59(4).0003","url":null,"abstract":"<p><strong>Background: </strong>Most of the reports showed that videolaryngoscopy has better outcomes than direct laryngoscopy for nasotracheal intubation. The FKScope® comprises a semirigid and malleable stylet with a terminal camera and has been used to facilitate orotracheal intubation. However, its efficacy and safety for nasotracheal intubation remain unknown. This study compared FKScope® with Macintosh direct laryngoscopy for nasotracheal intubation.</p><p><strong>Methods: </strong>Sixty-four patients scheduled for oral and maxillofacial surgery requiring nasotracheal intubation were enrolled and randomly assigned to FKScope® (n = 32) or Macintosh group (n = 32). The primary outcome was time to successful intubation during the first attempt. Secondary outcomes included modified nasal intubation difficulty scale (MNIDS) scores; percentage of glottic opening (POGO); immediate postintubation side effects such as mucosal bleeding, dental injury, and lip lacerations; and postoperative side effects including nasal pain, sore throat, hoarseness, dysphagia, and dyspnea.</p><p><strong>Results: </strong>The rates of successful first-attempt intubation were 87.5% and 90.6% in the FKScope® and Macintosh group, respectively (P = 0.69). Mean (± standard deviation) total intubation time was 68.7 ± 34.8 s in the FKScope® group compared with 61.5 ± 21.9 s in the Macintosh group (P = 0.35), despite a higher POGO for the FKScope® group (77 ± 27 vs. 41 ± 31, P ＜ 0.01). The MNIDS scores of the FKScope® group were significantly lower (0.8 ± 1.0 vs. 2.8 ± 1.4, P ＜ 0.01). The groups did not differ significantly regarding most postoperative side effects, although the FKScope® group had fewer lip lacerations (P = 0.04).</p><p><strong>Conclusions: </strong>The use of FKScope® improves the view of the glottic opening and is safe for nasotracheal intubation with normal airways. However, secretions and blood can obstruct the camera, and therefore, to select the patient carefully is necessary.</p>","PeriodicalId":8482,"journal":{"name":"Asian journal of anesthesiology","volume":"59 4","pages":"152-160"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39870931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Combination Between Ketamine and Parecoxib as Multimodal Preemptive Analgesia With Ketamine Alone for Elective Laparotomy.","authors":"Rabiatul Aida Ramli,&nbsp;Wan Mohd Nazaruddin Wan Hassan,&nbsp;Saedah Ali,&nbsp;Abdul Karim Othman,&nbsp;Rhendra Hardy Mohamad Zaini,&nbsp;Mohamad Hasyizan Hassan","doi":"10.6859/aja.202112_59(4).0004","DOIUrl":"https://doi.org/10.6859/aja.202112_59(4).0004","url":null,"abstract":"<p><strong>Background: </strong>Preemptive analgesia is important for reducing postoperative analgesia requirement. Therefore, this study compared the efficacy of intravenous (IV) ketamine alone with the efficacy of a combination of low-dose IV ketamine and IV parecoxib as part of a multimodal preemptive analgesia regimen in patients undergoing elective laparotomy.</p><p><strong>Methods: </strong>In this prospective study, 48 patients scheduled for elective laparotomy were randomized to two groups of preemptive analgesia, namely, group K-P, in which anestheologists administered a combination of 0.3 mg/kg IV ketamine and 40.0 mg IV parecoxib, or group K, in which ones gave 0.3 mg/kg IV ketamine alone. Patients from both groups underwent surgery under general anesthesia, and total intraoperative opioid requirement was recorded. After surgery, morphine administered by automated patient-controlled analgesia (PCA) infusion device was initiated in all patients. Pain score was assessed using the visual analogue scale (VAS), and postoperative opioid requirement was recorded at 1 and 4 hours, and subsequently from 4-hour intervals up to 24 hours after surgery.</p><p><strong>Results: </strong>Compared to group K, group K-P required significantly lower rescue IV fentanyl in the recovery bay (0.10 ± 0.28 vs. 0.35 ± 0.46 μg/kg; P = 0.031), showing prolonged time-to-first analgesic request recorded by PCA device (70.8 ± 40.0 vs. 22.2 ± 15.8 mins; P ＜ 0.001), lower total morphine requirement delivered by PCA device (8.0 ± 4.6 vs. 16.8 ± 6.5 mg; P ＜ 0.001), and lower VAS values measured at all time points. There was no significant difference in intraoperative total opioid requirement between the groups.</p><p><strong>Conclusions: </strong>Among laparotomy patients, multimodal preemptive analgesia by the use of a combination of low-dose IV ketamine and IV parecoxib was more effective than IV ketamine alone in reducing pain scores and postoperative analgesia requirement (e.g., PCA-administered morphine).</p>","PeriodicalId":8482,"journal":{"name":"Asian journal of anesthesiology","volume":"59 4","pages":"161-168"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39870932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}