预先肌注曲马多对硬膜外麻醉后病人寒战的影响

目的 探讨肌肉注射曲马多对硬膜外麻醉后寒战的预防效果。方法 选择80例准备在硬膜外麻醉下行下腹、下肢或脊柱手术的成年患者,随机分为四组（每组20例）：肌注曲马多和氟哌利多组（TD组）;单纯曲马多组（T组）或氟哌利多组（D组）;对照组（C组）。于硬膜外注药前30分钟,TD组肌注曲马多1．5mg/kg和氟哌利多5mg;T组肌注曲马多1．5mg/kg;D组肌注氟哌利多5mg;C组不用药。观察麻醉及手术过程中寒战的发生率、寒战的严重程度及寒战发生前后体温变化。结果 寒战发生率TD组和T组均为5％,D组和C组分别为25％和35％,TD组和T组与C组比较差异显著（P＜0．05）。TD组哮睡发生率、T组恶心发生率较高。结论 肌注曲马多有助于预防低位硬膜外麻醉后寒战,应用时复合氟哌利多可减少曲马多的副作用。     

帕瑞昔布钠预防硬膜外麻醉后寒战的临床观察

目的探讨预先静注帕瑞昔布钠对硬膜外麻醉后寒战的预防效果。方法选择硬膜外麻醉下行择期经尿道前列腺切除手术患者120例,随机均分为两组。硬膜外麻醉前30 min分别静注帕瑞昔布钠40 mg(P组)或等容量生理盐水(C组)。观察麻醉及手术过程中寒战的发生率、寒战的严重程度及寒战发生前后体温变化。结果 P组患者寒战发生率为5%,而C组为25%,P组明显低于C组(P<0.05)。结论预先静注帕瑞昔布钠40 mg可有效预防硬膜外麻醉后寒战的发生。     

哌替啶、氟哌啶治疗硬膜外麻醉期寒战

我们用哌替啶、氟哌啶(简称哌氟合剂)治疗硬膜外麻醉期寒战反应120例,均为成人,主要是腹部和下肢手术。常规于T_(8～9)或T_(11～12)椎间隙穿刺置管,局麻药用1％利多卡因和0.25％丁卡因混合液(含肾上腺素1:20万)。寒战均发生于开放静脉、硬膜外注局麻药后或手术野消毒期间。当寒战出现并持续2min以上不消失时即给哌氟合剂(哌替啶25～50mg、氟哌啶2.5～5mg)经莫非氏滴管静脉滴入,同时给予布单覆盖病人非手术区以保暖。 120例病人中静脉滴入哌氟合剂后5min内寒战消失者116例,有效率占97％。另4例寒战反应有所减弱,结合保暖后寒战停止。用药后,1/3病人呈嗜睡状态,     

哌氟合剂及红外线热幅射应用于防治硬膜外麻醉中寒战

随机选择硬膜外麻醉择期手术病人160例,分为三组,即治疗组、药物预防组和药物加红外线热幅射预防组。分别应用哌氟合剂(哌替啶25～50mg及氟哌啶2.5～5mg)及哌氟合剂加红外线热幅射防治硬膜外麻醉中寒战反应。结果表明哌氟合剂静滴消除寒战有效率达96.6%,预防有效率94%。哌氟合剂加红外线热幅射保温均无寒战发生。     

曲马多治疗椎管内麻醉病人寒战反应的临床研究

我院自 1999年 1月以来将曲马多用于制止椎管内麻醉病人的寒战反应 ,效果良好 ,并与哌替啶进行了对比观察 ,现报告如下。资料与方法一般资料　椎管内麻醉期间发生寒战反应的病人 15 0例 (麻醉前已有寒战或已用阿片类药物以后出现者除外 ) ,ＡＳＡⅠ～Ⅱ级 ,男 6 8例 ,女 82例 ,年龄 15～ 5 8岁 ,体重 42～76ｋｇ。腰麻 41例 ,硬膜外麻醉 10 9例。病人进入手术室前30分钟常规肌肉注射苯巴比妥钠 0 1ｇ、阿托品 0 5ｍｇ。病人进入手术室后室温调节在 2 0～ 2 6℃。分组及用药　根据随机原则将病人分为三组 ,每组 5 0例。在寒战反应发生后分…     

几种辅助用药预防阑尾牵拉反应的效果比较

作者将175例腰麻或硬膜外阻滞下阑尾切除手术病人分为7组,每组25例。组1阑尾系膜封闭,组2哌替啶50mg,组3除哌替啶外另加异丙嗪25mg,组4氟哌啶5mg,组5除氟哌啶外另加芬太尼50μg,组6为芬太尼100μg,组7为生理盐水2ml。组2至组7用药均在手术开始时静注。根据牵拉阑尾时能否消除病人不适感、上腹部疼痛、或伴有血压脉率变化、甚至恶心、鼓肠等反应的程度从优到劣评为0、1、2、3四级。结果以组5及组6的0级分别占16/25和19/25,1级分别占9/25和6/25,提示     

右美托咪定和曲马多治疗术后寒战效果的比较

目的 比较右美托咪定和曲马多静脉注射用于治疗术后寒战的效果.方法 90例全身麻醉后寒战级别为3～4级行腹部手术的患者,随机均分为三组:分别静注右美托咪定0.μg/kg(A组)、曲马多1 mg/kg(B组)和生理盐水(C组).并按设定的时间间隔评估寒战级别和药物的不良反应.结果 给药后5 min A、B组寒战级别较C组降低(P＜0.05).B组恶心呕吐发生率高于A、C两组(P＜0.05),A组的镇静评分高于B、C组.结论 静注右美托咪定0.5μg/kg可以有效治疗术后寒战,恶心呕吐不良反应少.     

曲马多对颅脑手术浅低温麻醉苏醒期病人肌颤反应的影响

目的 评价颅脑手术浅低温麻醉苏醒期静注曲马多防治肌颤反应的效果。方法 90例拟行颅内手术病人随机分为A、B、C三组,每组30例。麻醉中应用降温毯将体温降至34.4℃。A组在缝合皮肤时静注曲马多200 mg,苏醒期出现肌颤时追加50 mg/次;B、C组在术后发生肌颤时静注曲马多,B组50rag/次,C组100mg/次,用药后5min肌颤未消失或再出现肌颤时重复应用原设定剂量。结果 A、B和C组的肌颤率分别是33％、73％和76％,A组明显低于B组和c组(P<0.01)。A组肌颤程度评级和术后恶心呕吐发生率均低于B组、C组(P<0.01)。结论 手术结束前静注曲马多能有效防治苏醒期的肌颤反应,且副作用较低。     

布拉诺、曲马多复合氟哌利多预防硬膜外阻滞下剖宫产牵拉反应的比较

目的:剖宫产术中牵拉反应较为常见,我们采用布拉诺、曲马多分别复合氟哌利多预防术中牵拉反应,取得了较好效果。方法:选择硬膜外麻醉下初产妇180例,ASAⅠ级。随机分成三组,A组于术前肌注布拉诺8mg,氟哌利多3mg;B组于术前肌注曲马多0 1,氟哌利多3mg;C组不用辅助药物,术中监测EKG、SpO_2、Bp、R、HR及镇痛效果,胎儿Apqar评分。结果:A、B两组术中抗牵拉反应效果好,优于C组(P<0.01),且对胎儿无影响。结论:用布拉诺、曲马多复合氟哌利多预防硬外麻醉下牵拉反应是两种较好的选择,且布拉诺与氟哌利多副作用少,更适用于产科手术。     

曲马多持续静注预防硬膜外阻滞下腹部手术中寒战发生的效果

曲马多对全麻术后寒战的发生有明显的治疗效果[1] ,但有关曲马多预防术中寒战的发生尚未见报道 ,本研究拟观察曲马多持续静注预防硬膜外阻滞下腹部手术中寒战发生的效果。资料与方法　选择下腹部手术 6 0例 ,男 2 7例 ,女 33例 ,年龄 (43± 14)岁 ,术前ＡＳＡⅠ～Ⅱ级。随机分为 3组 :对照组、试验组Ⅰ及试验组Ⅱ ,每组 2 0例。术前 30ｍｉｎ肌肉注射苯巴比妥钠0 1ｇ,阿托品 0 5ｍｇ。在硬膜外穿刺前 ,对照组 5ｍｉｎ内静注生理盐水 5 0ｍｌ,继之以 0 2ｍｌ·ｍｇ-1·ｍｉｎ-1的速率微泵维持至术闭 ;试验组Ⅰ及试验组Ⅱ 5ｍｉｎ内静注曲…     

右美托咪定与曲马多在下肢手术中预防寒战及镇静程度的比较

【摘要】〓目的〓比较右美托咪定与曲马多在防治腰硬联合麻醉下行下肢手术术中寒战的发生率及镇静程度。方法〓选择ASAⅠ~Ⅱ级择期经腰硬联合麻醉行下肢手术患者60例,随机分成3组:右美托咪定组(D组)采用静脉推注0.5 ?滋g/kg的右美托咪定),曲马多组(T组)静脉推注2 mg/kg的曲马多,空白对照组(C组)静脉推注等量生理盐水,3组均在实施腰硬联合麻醉前10 min内给完所需药量,比较三组患者血流动力学的变化、寒战的发生率及镇静评分。结果〓与C组比较,D组和T组均能降低患者寒战的发生率,差异有统计学意义(P<0.05);与T组比较,D组使用的右美托咪定能提高患者的镇静评分,且无恶心呕吐等不良反应的发生。结论〓右美托咪定与曲马多在腰硬联合麻醉前静脉泵注,能够有效降低寒战反应发生率,右美托咪定更能提高患者的镇静满意度,且无药物不良反应发生。     

Nefopam and tramadol for the prevention of shivering during neuraxial anesthesia

BACKGROUND AND OBJECTIVES: In patients undergoing neuraxial anesthesia, heat loss and core-to-peripheral redistribution of body heat causes the core temperature to decrease. The shivering threshold is therefore reached soon, and more shivering is required to prevent further hypothermia. Because shivering has deleterious metabolic and cardiovascular effects, it should ideally be prevented by pharmacologic or other means. We evaluated the usefulness of intravenous (IV) nefopam and tramadol in preventing and reducing the severity of shivering in patients undergoing neuraxial anesthesia for orthopedic surgery. METHODS: Ninety patients, scheduled for neuraxial anesthesia (epidural or subarachnoid) for lower limb orthopedic surgery, were prospectively enrolled. Patients were randomly assigned to 1 of 3 groups. Immediately before neuraxial anesthesia, 30 patients received 0.15 mg/kg(-1) IV nefopam in 10 mL saline, 30 patients received 0.5 mg/kg(-1) IV tramadol in 10 mL saline, and a control group of 30 patients received 10 mL IV saline. Neuraxial anesthesia was induced at the L3-L4 or L4-L5 interspaces with 1 mg/kg(-1) mepivacaine for epidural anesthesia and 0.2 mg/kg(-1) for subarachnoid anesthesia. An investigator blinded to the antishivering drug injected recorded the frequency and degree of shivering. RESULTS: The overall frequency and the intensity of shivering was significantly lower in patients treated with nefopam than in those treated with tramadol or placebo (P <.05 and P <.01) and in patients treated with tramadol than in those treated with placebo (P <.05). CONCLUSIONS: As a pharmacologic means of preventing shivering in patients undergoing neuraxial anesthesia, nefopam may hold the greatest promise.     

Tramadol for postoperative shivering: a double-blind comparison with pethidine

In most operating and recovery rooms, shivering is controlled by the use of humidifiers, warming blankets, and inhalation of humidified heated oxygen. However, pharmacological control is an effective alternate treatment modality. This randomized, double-blind trial, conducted in 30 ASA Grade 1 or 2 patients, was designed to explore the efficacy of tramadol and pethidine in the treatment of post-anaesthetic shivering. Tramadol is an inhibitor of the re-uptake of serotonin (5-hydroxytryptamine) and norepinephrine in the spinal cord. This facilitates 5-hydroxytryptamine release, which influences thermoregulatory control. We compared the efficacy of tramadol with that of pethidine, presently a widely used drug for the control of shivering. Patients received either tramadol 1 mg/kg or pethidine 0.5 mg/kg intravenously and the grade of shivering, pulse rate, blood pressure and respiratory rate were observed every 10 minutes after injection for one hour Shivering was significantly more likely to have ceased in the tramadol group (12 of 15 versus 4 of 15 cases, P<0.05) at 10 minutes after drug administration and this control was better sustained. No patients receiving tramadol had a recurrence of shivering. It is concluded that intravenous tramadol 1 mg/kg is more effective for the treatment of postoperative shivering than pethidine 0.5 mg/kg.     

Epidural fentanyl speeds the onset of sensory block during epidural lidocaine anesthesia

BACKGROUND AND OBJECTIVES: Shortening the onset time of sensory block is a practical goal to improve the quality of epidural anesthesia. The addition of fentanyl to a local anesthetic solution is widely used during epidural anesthesia. This randomized double-blind study examined the onset time of sensory block during epidural lidocaine anesthesia with and without added fentanyl to the epidural solution. METHODS: Thirty-six young male patients undergoing knee arthroscopy were randomly allocated into 3 groups of 12 patients each: epidural fentanyl (EF, epidural administration of 17 mL of 2% lidocaine plus 100 microg fentanyl and followed by intravenous (IV) injection of 2 mL of normal saline); IV fentanyl (IF, epidural administration of 17 mL of 2% lidocaine plus 2 mL of normal saline and followed by IV injection of 100 microg of fentanyl); and control (C, epidural administration of 17 mL of 2% lidocaine plus 2 mL of normal saline and followed by IV injection of 2 mL of normal saline). The sensory block was assessed by pinprick method. The hemodynamic changes, postepidural shivering, and side effects of epidural fentanyl were also recorded. RESULTS: There was no difference in the distribution of age, weight, and height among the 3 groups. The onset time of sensory block up to T(10) dermatome was significantly more rapid in the EF group (8.3 +/- 3.7 minutes) than that of the IF group (13.1 +/- 4.2 minutes, P <.05) or C group (14.2 +/- 5.4 minutes, P <.05). The upper level of sensory block was also significantly higher in the EF group. Although the incidence of shivering was lower in the EF group, this did not reach statistical significance. Postepidural arterial blood pressures and heart rates were no different among the 3 groups. No nausea, vomiting, pruritus, respiratory depression, urinary retention, or hypotension were observed in any patients. CONCLUSION: Epidural injection of the mixture of 100 microg fentanyl and 2% lidocaine solution accelerated the onset of sensory block during epidural lidocaine anesthesia without increased side effects.     

右美托咪定预防经尿道前列腺切除术中寒战发生的效果

目的 观察右美托咪定预防经尿道前列腺切除术中寒战发生的效果。 方法 90例择期在腰硬联合麻醉下行经尿道前列腺切除术（TURP）患者,随机等分为3组（n=30）：D组（右美托咪定）、T组（曲马多）、C组（对照组）。麻醉后分别于10分钟内持续静脉泵注右美托咪定0.5μg/kg、曲马多1mg/kg或等量生理盐水, 记录3组患者的平均动脉压（MAP）、心率（HR）、血氧饱和度（SpO2）,评估患者术中寒战级别和恶心、呕吐等不良反应。 结果 D组寒战级别低于C组（P<0.05）,D、T组寒战级别无明显差异（P>0.05）, D组恶心、呕吐发生率较T组降低（P<0.05）,D组血压、心率低于T、C组（P<0.05）。 结论 0. 5ug/kg右美托咪定可以有效预防经尿道前列腺切除术中寒战,效果与1mg/kg曲马多相当,而恶心、呕吐不良反应少。     

Prophylactic ketamine to prevent shivering in parturients undergoing Cesarean delivery during spinal anesthesia

Study ObjectiveTo compare the efficacy and safety of ketamine 0.25 mg/kg with ketamine 0.5 mg/kg to prevent shivering in patients undergoing Cesarean delivery.DesignProspective, randomized, double-blinded, placebo-controlled study.SettingOperating rooms and postoperative recovery rooms.Patients120 ASA physical status 1 and 2 pregnant women scheduled for Cesarean delivery during spinal anesthesia.MeasurementsPatient characteristics, anesthetic and surgical details, Apgar scores at 1 and 5 minutes, and side effects of the study drugs were recorded. Heart rate, mean arterial pressure, oxygen saturation via pulse oximetry, tympanic temperature, severity of shivering, and degree of sedation were recorded before intrathecal injection and thereafter every 5 minutes. Patients were randomized to three groups: saline (Group C, n=30), intravenous (IV) ketamine 0.25 mg/kg (Group K-0.25, n=30), or IV ketamine 0.5 mg/kg (Group K-0.5, n=30). Grade 3 or 4 shivering was treated with IV meperidine 25 mg and the prophylaxis was regarded as ineffective.Main ResultsThe number of shivering patients was significantly less in Group K-0.25 and in Group K-0.5 than in Group C (P = 0.001, P = 0.001, respectively). The tympanic temperature values of Group C were lower at all times of the study than in either ketamine group. Median sedation scores of Group K-0.5 were significantly higher than in Group K-0.25 or Group C at 10, 20, 30, and 40 minutes after spinal anesthesia.ConclusionsProphylactic IV ketamine 0.25 mg/kg was as effective as IV ketamine 0.5 mg/kg in preventing shivering in patients undergoing Cesarean section during spinal anesthesia.     

Shivering related to epidural blockade with bupivacaine in labour, and the influence of epidural pethidine

A prospective survey of two hundred patients who received an epidural block in labour was performed in order to determine the incidence and severity of shivering, and the influence of likely associated factors. Twenty-two of the patients who shivered took part in a double-blind trial to see if epidural pethidine 25 mg, versus saline, had any effect upon shivering. Fifty per cent of patients shivered soon after the initial dose of bupivacaine. Shivering was more common among patients who had experienced shivering before epidural block, and in those who had received nitrous oxide (P less than 0.005). Prior intramuscular injection of pethidine did not significantly affect the incidence of shivering, and it was not influenced by the concentration of epidural bupivacaine used (0.5 or 0.25%). Shiverers were more likely to feel cold than non-shiverers (P less than 0.001) but shivering was generally regarded by patients as a trivial symptom, only 13% describing it as very irritating. Shivering was abolished or considerably diminished within ten minutes in all patients who received epidural pethidine 25 mg, whereas there was no change in eight out of eleven patients who received epidural saline. These results are significant (P less than 0.01), and demonstrate that shivering following epidural blockade can be effectively treated with small epidural doses of pethidine.     

Combined general and epidural anesthesia with ropivacaine for renal transplantation

AIM: To evaluate the effectiveness and safety of epidural ropivacaine anesthesia in association with light general anesthesia during renal transplantation and compare epidural and endovenous analgesia techniques for postoperative pain control. METHODS: Experimental design: prospective randomized study. SETTING: Organ Transplantation Center, Department of Surgery, "Tor Vergata" University of Rome, St. Eugenio Hospital, Rome. PATIENTS: 25 patients affected by chronic renal failure were enrolled in this study. Thirteen constituted the combined epidural-general anesthesia group (EPI-GEN), mean age 40.15+/-9.81 years; while the others constituted the general anesthesia group (GEN), mean age 46.75+/-7.45 years. Operation: cadaveric renal transplantation. Group EPI-GEN: epidural anesthesia performed with 12-15 ml of a ropivacaine 0.75% and fentanyl 5 microg/ml solution followed by light intravenous or inhalatory general anesthesia and postoperative epidural analgesia with ropivacaine 0.2% and fentanyl 2 mg/ml. Group GEN: inhalatory or intravenous general anesthesia and intravenous tramadol postoperative analgesia. Measurements: hemo-dynamics, renal function, arterial blood gases analysis, acid-base balance and postoperative pain data was collected and examined. RESULTS: Postoperative epidural analgesia resulted significantly more effective than intravenous tramadol. PaO(2)/FiO(2) ratio was significantly higher in group EPI-GEN patients both on awakening and throughout postoperative observation. Hemodynamics and renal function did not appear to differ significantly. CONCLUSION: Combined epidural-general anesthesia is as valid a technique as any for renal transplantation; however postoperative epidural ropivacaine analgesia resulted more effective than intravenous tramadol. Respiratory function appeared less affected, facilitating a fast and uncomplicated postoperative recovery.