L’esmolol versus l'association kétamine-rémifentanil pour une analgésie postopératoire précoce après cholécystectomie par laparoscopie: une étude randomisée contrôlée

López-Álvarez, S.; Moldes, M. Mayo; Zaballos, M.; Iglesias, Belén García; Blanco-Dávila, Rafael

doi:10.1007/s12630-012-9684-x

Cited by 29 publications

(45 citation statements)

References 31 publications

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“…In our view, this methodological distinction probably accounts for the different doses of esmolol and remifentanil in the Collard et al study compared with ours (1.3 vs 5.2 mgÁkg -1 ; and 7.6 vs 21 lgÁkg -1 , respectively). 1,5 We sincerely hope that this explanation resolves any confusion regarding the doses of esmolol administered in our study, as reflected in Table 1 of the article.…”

Section: Replymentioning

confidence: 67%

“…1 We had originally planned to use a bolus dose of esmolol 0.5 mgÁkg -1 iv to be followed by a continuous infusion titrated according to patient requirements, at a rate from 5-15 lgÁkg -1 Ámin -1 , to maintain mean arterial pressure and heart rate within 20% of the patients' respective baseline values. However, soon after initiation of the study, we found that the dosing regimen initially planned made it impossible to achieve and maintain the desired hemodynamic goals.…”

Section: Replymentioning

confidence: 99%

“…1 I read the article with great interest, but I am confused about the esmolol dosing regimen that is reported. In the methods section, the dose of esmolol was reported as 0.5 mgÁkg -1 iv bolus, followed by a continuous infusion titrated from 5-15 lgÁkg -1 Ámin -1 to maintain the patient's mean arterial pressure and heart rate within 20% of respective baseline values.…”

Section: To the Editormentioning

confidence: 99%

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How much esmolol was administered?

Ozcan

2012

Can J Anesth/J Can Anesth

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To the Editor,In their recent article, Lopez-Alvarez et al. compared an esmolol infusion vs ketamine-remifentanil combination for their effects on postoperative analgesia.1 I read the article with great interest, but I am confused about the esmolol dosing regimen that is reported. In the methods section, the dose of esmolol was reported as 0.5 mgÁkg -1 iv bolus, followed by a continuous infusion titrated from 5-15 lgÁkg -1 Ámin -1 to maintain the patient's mean arterial pressure and heart rate within 20% of respective baseline values. Reviewing Table 1 of the article, the mean total esmolol dose administered was 5.2 mgÁkg -1 , whereas the mean duration of anesthesia was 64 min. Mathematically, 4.7 mgÁkg -1 of the mean total dose had to be given as an infusion (since the bolus dose was 0.5 mgÁkg -1 iv in all patients). Therefore, even had the patient received the maximum stated dose of esmolol (i.e., 15 lgÁkg -1 Ámin -1 ) for the entire duration of anesthesia, this would have resulted in a mean total dose of esmolol of only 0.96 mgÁkg -1 . Adding the bolus dose would then bring the total dose to 1.46 mgÁkg -1 . Accordingly, there appears to be a considerable discrepancy between the esmolol dosing according to the methods (1.46 mgÁkg -1 , calculated for mean anesthetic duration assuming the maximum infusion rate) and the results (5.2 mgÁkg -1 ). I would be curious to hear from the authors as to whether they used a much bigger dose range of esmolol or whether they miscalculated the total esmolol dose reported in Table 1 of their article. ReplyWe sincerely thank Dr. Ozcan for his interest in our article and welcome the opportunity to clarify the esmolol dosing regimen that we reported. 1 We had originally planned to use a bolus dose of esmolol 0.5 mgÁkg -1 iv to be followed by a continuous infusion titrated according to patient requirements, at a rate from 5-15 lgÁkg -1 Ámin -1 , to maintain mean arterial pressure and heart rate within 20% of the patients' respective baseline values. However, soon after initiation of the study, we found that the dosing regimen initially planned made it impossible to achieve and maintain the desired hemodynamic goals. This was explained in the discussion section of our article, as we had to administer a much higher dose of esmolol [mean (standard deviation) dose of 382 (255) mg, equivalent to 5.2 mgÁkg -1 ]. This dose was similar to that reported by Chia et al., who administered a mean esmolol dose of 375.4 (143.4) mg, which showed an opioid-sparing effect of this drug.2 The opioid -sparing effect of esmolol has been described previously within this dose range in two other studies. 3,4 In contrast, Collard et al. used lower doses of esmolol (approximately 94 mg). In their study, both esmolol and remifentanil were titrated to maintain a heart rate within ± 20% of each subject's baseline value. In our view, this methodological distinction probably accounts for the different doses of esmolol and remifentanil in the

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Section: Replymentioning

confidence: 67%

Section: Replymentioning

confidence: 99%

Section: To the Editormentioning

confidence: 99%

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How much esmolol was administered?

Ozcan

2012

Can J Anesth/J Can Anesth

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“…Another randomized, placebocontrolled study stated the opioid-sparing effect of preemptive IV bolus ketamine (18). On the other hand, Lopez-Alvarez et al (19) indicated that morphine consumption and postoperative pain scores were higher in the group in which ketamine was administered. However, in this study, ketamine was only administered at induction; then, the patients received remifentanil infusion during the surgery.…”

Section: Discussionmentioning

confidence: 99%

Does the Method and Timing of Intravenous Ketamine Administration Affect Postoperative Morphine Requirement After Major Abdominal Surgery?

Biçer¹,

Etı²,

Saraçoğlu³

et al. 2014

Turk J Anesth Reanim

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Original Article / Özgün Araştırma 320 Amaç: Tek doz intravenöz bolus uygulama, postoperatif veya peroperatif infüzyon yoluyla verilmesi ketaminin en çok tercih edilen uygulama yöntemlerindendir. Bununla beraber, ideal ketamin uygulama yöntemi konusunda net bir konsensus bulunmamaktadır. Bu çalışmada, en sık kullanılan ketamin uygulama yöntemleri ve zamanlarının postoperatif opioid tüketimi üzerine olan etkilerini karşılaştırmayı amaçladık.Yöntemler: Kolon kanseri için kolektomi ameliyatı geçirecek 52 hasta randomize olarak 4 gruba ayrıldı. Grup 1 kontrol grubuydu. Grup 2 indüksiyonda 0,5 mg kg -1 tek bolus doz intravenöz ketamin aldı. Grup 3 indüksiyonda 0,5 mg kg -1 bolus intravenöz ketamini takiben 0,25 mg kg -1 sa -1 hızda peroperatif intravenöz ketamin infüzyonu aldı. Grup 4 indüksiyonda 0,5 mg kg -1 bolus intravenöz ketamini takiben 0,25 mg kg -1 sa -1 hızda peroperatif ve postoperatif dönemde intravenöz ketamin infüzyonu aldı. Postoperatif ağrı skorları, yan etkiler ve morfin tüketimleri kaydedildi. Bulgular:Postoperatif ağrı skorlarında istatistiksel olarak anlamlı bir fark yoktu. Grup 4'de diğer gruplarla karşılaştırıldığında toplam morfin tüketimi daha az bulundu (p=0,03, p=0,004, p=0,03, gruplarda sırasıyla). Postoperatif 1, 2 ve 4. saatlerde hasta kontrollü analjeziyle morfin tüketimi Grup 4'de kontrol grubundan anlamlı olarak daha düşüktü (p<0,01).Sonuç: Preoperatif tek bolus doz yada intraoperatif düşük doz ketamin infüzyonu postoperatif morfin tüketimini azaltmamış-ken, per-ve postoperatif 48 saatlik ketamin infüzyonu uygulaması büyük abdominal cerrahi geçiren hastalarda yan etki insidansını artırmadan morfin tüketiminde anlamlı bir azalmayla sonuçlan-mıştır.Anahtar Kelimeler: Ketamin, postoperatif analjezi, kolektomi, morfin Objective: Single intravenous bolus administration and postoperative or perioperative infusions are the most preferred methods of ketamine. Nevertheless, there is no clear explanation on the ideal ketamine administration method. In this study, we aimed to compare the effects of the most common ketamine administration methods and administration time on postoperative opioid consumption. Methods:Fifty-two patients undergoing colectomy for colon cancer were randomly assigned into four groups. Group 1 was the control group. Group 2 received only a single intravenous bolus dose of 0.5 mg kg -1 ketamine at induction. Group 3 received 0.5 mg kg -1 intravenous ketamine bolus at induction and perioperative ketamine infusion at a rate of 0.25 mg kg -1 h -1. Group 4 received a bolus of 0.5 mg kg -1 intravenous ketamine at induction and perioperative and postoperative ketamine infusion at a rate of 0.25 mg kg -1 h -1. Postoperatively, visual analogue scale pain scores, side effects, and morphine consumption were recorded.Results: There was no statistically significant difference in postoperative pain scores. Total morphine consumption was found to be significantly lower in Group 4 compared to the other groups (p=0. 03, p=0.004, p=0.03, respectively). During the 1 st , 2 nd , and 4 th hour...

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“…Five studies were placebo-controlled [5,[9][10][11][12], five were active-controlled [13][14][15][16][17], and one was placebo-and active-controlled [18]. Trial sizes ranged between 40 and 100 patients.…”

Section: Study Descriptionsmentioning

confidence: 99%

Beta-adrenergic antagonists during general anesthesia reduced postoperative pain: a systematic review and a meta-analysis of randomized controlled trials

et al. 2015

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We have performed a systematic literature review and a meta-analysis investigating the effect of beta-adrenergic antagonist on perioperative pain in randomized clinical trials (RCTs). The search included the CENTRAL, CINAHL, EMBASE, and MEDLINE databases (from inception to 10 February 2015). From the retrieved full texts, we hand-searched the references and PubMed related citations. A total of 11 RCTs consisting data of 701 adult patients were eligible for this systematic review. Esmolol was evaluated in ten trials and propranolol in one. Esmolol decreased the need for rescue analgesics by 32-50%; p < 0.05 (n = 7) and the proportion of patients needing rescue analgesia from 100 to 65%; p < 0.005 (n = 1), and propranolol decreased the need for rescue analgesics by 72%; p < 0.001 (n = 1). The time to the first rescue analgesics was longer (p < 0.05) and pain ratings were lower (p < 0.05) in patients with beta-adrenergic antagonists. However, in two opioid-controlled studies, one in knee arthroscopy and another in tubal ligation patients, the proportion of patients needing rescue analgesia was two-times higher in esmolol-treated patients: 52-57 vs. 23-34%, p < 0.05. Adverse effects were rarely reported, and as reported were mostly cardiovascular alterations. In conclusion, intra-operative beta-adrenergic antagonists' administration may decrease postoperative pain and analgesic consumption when given as an adjuvant to general anesthesia.

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L’esmolol versus l'association kétamine-rémifentanil pour une analgésie postopératoire précoce après cholécystectomie par laparoscopie: une étude randomisée contrôlée

Abstract: Intraoperative esmolol infusion reduces morphine requirements and provides more effective analgesia compared with a combination of remifentanil-ketamine given by infusion in patients undergoing LC.

Cited by 29 publications

References 31 publications

How much esmolol was administered?

How much esmolol was administered?

Does the Method and Timing of Intravenous Ketamine Administration Affect Postoperative Morphine Requirement After Major Abdominal Surgery?

Beta-adrenergic antagonists during general anesthesia reduced postoperative pain: a systematic review and a meta-analysis of randomized controlled trials

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