Intravenous acetaminophen in combination with remifentanil / nitrous oxide on post-tonsillectomy nausea-vomiting and pain in children-a randomised controlled trial
Abstract
SUMMARY
Objective: Many anesthesiologists have quit using nitrous oxide in their daily practice because of its side effects and also the introduction of short-acting opioids such as remifentanil. Our aim is to compare the effects of intraoperative remifentanil vs nitrous oxide in combination with iv acetaminophen on post-tonsillectomy pain in children
Method: Sixty-eight, pediatric patients undergoing adenonsillectomy operations were randomized into two groups of thirty-four each. General anaesthesia was induced by inhalation of sevoflurane (8%) in both groups. The nitrous oxide group (group I) received sevoflurane at an end-tidal conentration of 1.5-2, delivered with 70% nitrous oxide in oxygen. The remifentanil group (group II) also received sevoflurane in the same way but delivered in an oxygen-air gas mixture. Group II also received an intravenous (i.v.) infusion of remifentanil at 0.1-0.3 µg/kg-1 min-1. Both of the groups received i.v. acetaminophen infusions before surgical incision. Pain scores in the PACU and during the first 24 h were assessed.
Results: Demographics were similar among the groups. Twenty three patients in group I and 7 patients in group II have required rescue analgesia and time to first analgesia was longer in group II. Thirty-three (97.1%) patients in group I and 20 (58.8%) patients in group II needed analgesics at home. Pain scores in the PACU and at 24. hr were significantly lower in group II.
Conclusion: Combination of i.v. acetaminophen with remifentanil rather than nitrous oxide seems to be more suitable for outpatient adenotonsillectomy operation.
Keywords: Remifentanil, nitrous oxide, adenotonsillectomy surgery, pediatric anesthesia
ÖZET
Amaç: Birçok anestezist hem yan etki profili nedeniyle hem de kısa etkili bir opioid olan remifentanilin kullanıma girmesiyle günlük pratiklerinde nitröz oksit kullanımından vazgeçmişlerdir. Bu çalışmada amacımız, intraoperatif dönemde intravenöz (i.v.) yoldan uygulanan parasetamol beraberinde nitröz oksit veya remifentanilin çocuk hastalarda tonsillektomi sonrası ağrıya etkisinin incelenmesidir.
Method: Adenotonsillektomi planıyla cerrahiye alınan 68 pediyatrik yaş grubunda hasta 34 hastalık iki gruba ayrıldı. Her iki grupta da %8 sevofluran ile indüksiyon yapıldı. Nitröz oksit grubunda (Grup 1) %30/70 oksijen-nitröz oksit karışımı içinde sevofluran konsantrasyonu %1,5-2 olacak şekilde idame edildi. Remifentanil grubunda ise (Grup 2) %30/70 oksijen-hava karışımı içinde sevofluran konsantrasyonu %1,5-2 olacak şekilde idame edildi. Grup 2 hastalarında i.v. remifentanil infüzyonu (0.1-0.3 µg/kg/dk) yapıldı. Her iki grupta da cerrahi insizyon başlamadan önce i.v. asetaminofen (15 mg/kg) uygulandı. Ayılma ünitesinde ve 24. saatte ağrı skorları değerlendirildi.
Bulgular: Demografik veriler iki grupta da benzerdi. Grup 1’de 23 hastanın Grup 2’de ise 7 hastanın ek analjezik ihtiyacı oldu ve operasyon çıkışından ilk analjezik ihtiyacına kadar geçen süre Grup 2’de daha uzundu. Grup 1’de 33 hasta (%97,1), Grup 2’de ise 20 hastanın (%58,8) eve taburculuğunda analjezi ihtiyacı oldu. Grup 2’de ayılma ünitesinde ve postoperatif 24. saatte telefonla aranarak değerlendirilen ağrı skorları belirgin olarak daha düşüktü.
Sonuç: Günübirlik cerrahi olarak yapılan adenotonsillektomi operasyonlarında i.v. asetaminofen ve remifentanil kombinasyonunun nitröz oksite göre daha uygun bir tercih olduğu kanısındayız.
Anahtar sözcükler: Remifentanil, nitröz oksit, adenotonsillektomi cerrahisi, pediatrik anestezi
References
- Louis-Ferdinand RT. Myelotoxic, neurotoxic and reproductive ad- verse effects of nitrous oxide. Ad- verse Drug React Toxicol Rev 1994; 13: 193-206.
- Beals JK, Carter LB, Jevtovic- Todorovic V. Neurotoxicity of ni- trous oxide and ketamine is more severe in aged than in young rat brain. Ann N Y Acad Sci 2003; 993: 123-14.
- Jevtovic-Todorovic V, Beals J, Benshoff N, Olney JW. Prolonged exposure to inhalational anesthetic nitrous oxide kills neurons in adult rat brain. Neuroscience 2003; 122: 609-16.
- Apfel CC, Bacher A, Biedler A, Danner K, Danzeisen O, Eberhart LH. [A factorial trial of six inter- ventions for the prevention of postoperative nausea and vomit- ing]. Anaesthesist 2005; 54: 201-9.
- Schwilden H, Schuttler J. 200 years of nitrous oxide (laughing gas)-and the end of an era. Anasthesiol fallmed Schmerzther 2001; 36: 640. Not
- Sonander H, Stenqvist O, Nilsson K. Nitrous oxide exposure during routine anaesthetic work. Meas- urement of biologic exposure from urine samples and technical expo- sure by bag sampling. Acta Anaes- thesiol Scand 1985; 29: 203-8.
- Korttila K, Pfaffli P, Linnoila M, E, Blomgren Hakkinen S. Operating room nurs- es' psychomotor and driving skills after occupational exposure to hal- othane and nitrous oxide. Acta Anaesthesiol Scand 1978; 22: 33- 9. H,
- Egan TD, Minto CF, Hermann DJ, Barr J, Muir KT, Shafer SL. Rem- ifentanil versus alfentanil: com- parative pharmacodynamics adult male volunteers. Anesthesi- ology 1996; 84: 821-33. and in healthy
- Egan TD. Pharmacokinetics and pharmacodynamics of remifentan- il: an update in the year 2000. Curr Opin Anaesthesiol 2000; 13: 449
- Hannallah RS, Broadman LM, Belman AB, Abramowitz MD and Epstein BS. Comparison of caudal and nerve blocks for control of post- orchiopexy pain in pediatric ambu- latory surgery. 1987; 66: 832-4.
- Schuttler J, Schwilden H. [200 years of nitrous oxide-at the end of an era?]. Anasthesiol Intensivmed Notfallmed Schmerzther 2001; 36: 640.
- Kaisti KK, Langsjo JW, Aalto S, Oikonen V, Sipila H, Teras M. Ef- fects of sevoflurane, propofol, and adjunct nitrous oxide on regional cerebral blood flow, oxygen con- sumption, and blood volume in humans. Anesthesiology 2003; 99: 603-13.
- Belda FJ, Aguilera L, Garcia de la Asuncion J, Alberti J, Vicenti R, Ferrandiz L. Supplemental periop- erative oxygen and the risk of sur- gical wound infection: a random- ized controlled trial. Jama 2005; 294: 2035-42.
- Myles PS, Leslie K, Chan MT, Forbes A, Paech MJ, Peyton P. Avoidance of nitrous oxide for pa- tients undergoing major surgery: a randomized controlled trial. Anes- thesiology 2007; 107: 221-31.
- Badner NH, Beattie WS, Freeman D, Spence JD. Nitrous oxide- induced increased homocysteine concentrations are associated with increased postoperative myocardi- al ischemia in patients undergoing carotid endarterectomy. Anesth Analg 2000; 91: 1073-9.
- Myles PS, Leslie K, Silbert B, Paech MJ and Peyton P. A review of the risks and benefits of nitrous oxide in current anaesthetic prac- tice. Anaesth Intensive Care 2004; 32: 165-72.
- Davis PJ, Finkel JC, Orr RJ, Fazi L, Mulroy JJ, Woelfel SK. A ran- domized, double-blinded study of remifentanil versus fentanyl for tonsillectomy and adenoidectomy surgery in pediatric ambulatory surgical patients. Anesth Analg 2000; 90: 863-71.
- White MC, Nolan JA. An evalua- tion of pain and postoperative nau- sea and vomiting following the in- troduction of guidelines for tonsil- lectomy. Paediatr Anaesth 2005; 15: 683-8.
- Atef A, Fawaz AA. Intravenous paracetamol is highly effective in pain treatment after tonsillectomy in adults. Eur Arch Otorhinolaryn- gol 2007.
- Romsing J, Moiniche S, Dahl JB. Rectal and parenteral paracetamol, and paracetamol in combination with NSAIDs, for postoperative analgesia. Br J Anaesth 2002; 88: 215-26.
- Lang E, Kapila A, Shlugman D, Hoke JF, Sebel PS and Glass PS. Reduction of isoflurane minimal alveolar concentration by remifen- tanil. Anesthesiology 1996;
- Guignard B, Bossard AE, Coste C, Sessler DI, Lebrault C, Alfonsi P. Acute opioid tolerance: intraopera- tive remifentanil increases postop- erative pain and morphine re- quirement. Anesthesiology 2000; 93: 409-17.
- Vinik HR, Kissin I. Rapid devel- opment of tolerance to analgesia during remifentanil infusion in humans. Anesth Analg 1998; 86: 1307-11.
- Koppert W, Wehrfritz A, Korber N, Sittl R, Albrecht S, Schüttler J. The cyclooxygenase isozyme in- hibitors parecoxib and paracetamol reduce central hyperalgesia in hu- mans. Pain 2004; 108: 148-53.
- Troster A, Sittl R, Singler B, Schmelz M, Schuttler J, Koppert W. Modulation of remifentanil- induced analgesia and postinfusion hyperalgesia by parecoxib in hu- mans. Anesthesiology 2006; 105: 1016-1023.
- Jevtovic-Todorovic V, Todorovic SM, Mennerick S, Powell S, Dikranian K, Benshaff N. Nitrous oxide (laughing gas) is an NMDA antagonist, neuroprotectant and neurotoxin. Nat Med 1998; 4: 460
- Nagele P, Metz LB, Crowder CM. Nitrous oxide requires the N- methyl-D-aspartate receptor for its action in Caenorhabditis elegans. Proc Natl Acad Sci USA 2004; 101: 8791-6.
Çocuklarda tonsillektomi sonrası bulantı, kusma ve ağrı üzerine remifentanil/nitröz oksitle kombine intravenöz asetaminofen
Abstract
Amaç: Birçok anestezist hem yan etki profili nedeniyle hem de kısa etkili bir opioid olan remifentanilin kullanıma girmesiyle günlük pratiklerinde nitröz oksit kullanımından vazgeçmişlerdir. Bu çalışmada amacımız, intraoperatif dönemde intravenöz (i.v.) yoldan uygulanan parasetamol beraberinde nitröz oksit veya remifentanilin çocuk hastalarda tonsillektomi sonrası ağrıya etkisinin incelenmesidir. Method: Adenotonsillektomi planıyla cerrahiye alınan 68 pediyatrik yaş grubunda hasta 34 hastalık iki gruba ayrıldı. Her iki grupta da %8 sevofluran ile indüksiyon yapıldı. Nitröz oksit grubunda (Grup 1) %30/70 oksijen-nitröz oksit karışımı içinde sevofluran konsantrasyonu %1,5-2 olacak şekilde idame edildi. Remifentanil grubunda ise (Grup 2) %30/70 oksijen-hava karışımı içinde sevofluran konsantrasyonu %1,5-2 olacak şekilde idame edildi. Grup 2 hastalarında i.v. remifentanil infüzyonu (0.1-0.3 µg/kg/dk) yapıldı. Her iki grupta da cerrahi insizyon başlamadan önce i.v. asetaminofen (15 mg/kg) uygulandı. Ayılma ünitesinde ve 24. saatte ağrı skorları değerlendirildi. Bulgular: Demografik veriler iki grupta da benzerdi. Grup 1’de 23 hastanın Grup 2’de ise 7 hastanın ek analjezik ihtiyacı oldu ve operasyon çıkışından ilk analjezik ihtiyacına kadar geçen süre Grup 2’de daha uzundu. Grup 1’de 33 hasta (%97,1), Grup 2’de ise 20 hastanın (%58,8) eve taburculuğunda analjezi ihtiyacı oldu. Grup 2’de ayılma ünitesinde ve postoperatif 24. saatte telefonla aranarak değerlendirilen ağrı skorları belirgin olarak daha düşüktü. Sonuç: Günübirlik cerrahi olarak yapılan adenotonsillektomi operasyonlarında i.v. asetaminofen ve remifentanil kombinasyonunun nitröz oksite göre daha uygun bir tercih olduğu kanısındayız
References
- Louis-Ferdinand RT. Myelotoxic, neurotoxic and reproductive ad- verse effects of nitrous oxide. Ad- verse Drug React Toxicol Rev 1994; 13: 193-206.
- Beals JK, Carter LB, Jevtovic- Todorovic V. Neurotoxicity of ni- trous oxide and ketamine is more severe in aged than in young rat brain. Ann N Y Acad Sci 2003; 993: 123-14.
- Jevtovic-Todorovic V, Beals J, Benshoff N, Olney JW. Prolonged exposure to inhalational anesthetic nitrous oxide kills neurons in adult rat brain. Neuroscience 2003; 122: 609-16.
- Apfel CC, Bacher A, Biedler A, Danner K, Danzeisen O, Eberhart LH. [A factorial trial of six inter- ventions for the prevention of postoperative nausea and vomit- ing]. Anaesthesist 2005; 54: 201-9.
- Schwilden H, Schuttler J. 200 years of nitrous oxide (laughing gas)-and the end of an era. Anasthesiol fallmed Schmerzther 2001; 36: 640. Not
- Sonander H, Stenqvist O, Nilsson K. Nitrous oxide exposure during routine anaesthetic work. Meas- urement of biologic exposure from urine samples and technical expo- sure by bag sampling. Acta Anaes- thesiol Scand 1985; 29: 203-8.
- Korttila K, Pfaffli P, Linnoila M, E, Blomgren Hakkinen S. Operating room nurs- es' psychomotor and driving skills after occupational exposure to hal- othane and nitrous oxide. Acta Anaesthesiol Scand 1978; 22: 33- 9. H,
- Egan TD, Minto CF, Hermann DJ, Barr J, Muir KT, Shafer SL. Rem- ifentanil versus alfentanil: com- parative pharmacodynamics adult male volunteers. Anesthesi- ology 1996; 84: 821-33. and in healthy
- Egan TD. Pharmacokinetics and pharmacodynamics of remifentan- il: an update in the year 2000. Curr Opin Anaesthesiol 2000; 13: 449
- Hannallah RS, Broadman LM, Belman AB, Abramowitz MD and Epstein BS. Comparison of caudal and nerve blocks for control of post- orchiopexy pain in pediatric ambu- latory surgery. 1987; 66: 832-4.
- Schuttler J, Schwilden H. [200 years of nitrous oxide-at the end of an era?]. Anasthesiol Intensivmed Notfallmed Schmerzther 2001; 36: 640.
- Kaisti KK, Langsjo JW, Aalto S, Oikonen V, Sipila H, Teras M. Ef- fects of sevoflurane, propofol, and adjunct nitrous oxide on regional cerebral blood flow, oxygen con- sumption, and blood volume in humans. Anesthesiology 2003; 99: 603-13.
- Belda FJ, Aguilera L, Garcia de la Asuncion J, Alberti J, Vicenti R, Ferrandiz L. Supplemental periop- erative oxygen and the risk of sur- gical wound infection: a random- ized controlled trial. Jama 2005; 294: 2035-42.
- Myles PS, Leslie K, Chan MT, Forbes A, Paech MJ, Peyton P. Avoidance of nitrous oxide for pa- tients undergoing major surgery: a randomized controlled trial. Anes- thesiology 2007; 107: 221-31.
- Badner NH, Beattie WS, Freeman D, Spence JD. Nitrous oxide- induced increased homocysteine concentrations are associated with increased postoperative myocardi- al ischemia in patients undergoing carotid endarterectomy. Anesth Analg 2000; 91: 1073-9.
- Myles PS, Leslie K, Silbert B, Paech MJ and Peyton P. A review of the risks and benefits of nitrous oxide in current anaesthetic prac- tice. Anaesth Intensive Care 2004; 32: 165-72.
- Davis PJ, Finkel JC, Orr RJ, Fazi L, Mulroy JJ, Woelfel SK. A ran- domized, double-blinded study of remifentanil versus fentanyl for tonsillectomy and adenoidectomy surgery in pediatric ambulatory surgical patients. Anesth Analg 2000; 90: 863-71.
- White MC, Nolan JA. An evalua- tion of pain and postoperative nau- sea and vomiting following the in- troduction of guidelines for tonsil- lectomy. Paediatr Anaesth 2005; 15: 683-8.
- Atef A, Fawaz AA. Intravenous paracetamol is highly effective in pain treatment after tonsillectomy in adults. Eur Arch Otorhinolaryn- gol 2007.
- Romsing J, Moiniche S, Dahl JB. Rectal and parenteral paracetamol, and paracetamol in combination with NSAIDs, for postoperative analgesia. Br J Anaesth 2002; 88: 215-26.
- Lang E, Kapila A, Shlugman D, Hoke JF, Sebel PS and Glass PS. Reduction of isoflurane minimal alveolar concentration by remifen- tanil. Anesthesiology 1996;
- Guignard B, Bossard AE, Coste C, Sessler DI, Lebrault C, Alfonsi P. Acute opioid tolerance: intraopera- tive remifentanil increases postop- erative pain and morphine re- quirement. Anesthesiology 2000; 93: 409-17.
- Vinik HR, Kissin I. Rapid devel- opment of tolerance to analgesia during remifentanil infusion in humans. Anesth Analg 1998; 86: 1307-11.
- Koppert W, Wehrfritz A, Korber N, Sittl R, Albrecht S, Schüttler J. The cyclooxygenase isozyme in- hibitors parecoxib and paracetamol reduce central hyperalgesia in hu- mans. Pain 2004; 108: 148-53.
- Troster A, Sittl R, Singler B, Schmelz M, Schuttler J, Koppert W. Modulation of remifentanil- induced analgesia and postinfusion hyperalgesia by parecoxib in hu- mans. Anesthesiology 2006; 105: 1016-1023.
- Jevtovic-Todorovic V, Todorovic SM, Mennerick S, Powell S, Dikranian K, Benshaff N. Nitrous oxide (laughing gas) is an NMDA antagonist, neuroprotectant and neurotoxin. Nat Med 1998; 4: 460
- Nagele P, Metz LB, Crowder CM. Nitrous oxide requires the N- methyl-D-aspartate receptor for its action in Caenorhabditis elegans. Proc Natl Acad Sci USA 2004; 101: 8791-6.
Details
| Primary Language | English |
|---|---|
| Journal Section | Medical Science Research Articles |
| Authors | |
| Publication Date | February 13, 2015 |
| Published in Issue | Year 2015Volume: 37 Issue: 3 |