Pm'po~: In a randomized, double-blind clinical trial, we compared the postoperative analgesic effect and dose consumption of fentanyl after intraoperative high dose and low dose fentanyl administration. Methods: Sixty ASA class I to II female patients undergoing total abdominal hysterectomy CI-AH), were randomly allocated to receive either I Hg.kg -I (low dose group, n = 30) or 15 Hg.kg -a (high dose group, n = 30) fentanyl during induction of anesthesia. Anesthesia depth was maintained with inhalation of halothane in the low dose group, or combined with 100 Hg'hr -~ fentanyl iv in the high dose group. Postoperative pain was treated with an intravenous patient-controlled analgesia system and was assessed with a visual analog pain score at rest. R~ts: Patients in the high dose group had higher pain intensity at four and eight hours postoperatively, more fentanyl consumption and a greater incidence of emesis in the postoperative period of 16 hr than those in the low dose group (P < 0.05). Heart rate, blood pressure, and respiratory rate were similar between the two groups. C, oncJttdon: Our results suggest that acute fentanyl tolerance develops after administration of high dose fentanyl during surgery and, consequently, results in a higher postoperative pain intensity and greater fentanyl consumption. REsultats : Les patientes qui ont re~u la forte dose ont connu des douleurs plus intenses quatre et huit heures apr~s I'op&ation, ont pris davantage de fentanyl et ont eu une plus grande incidence de vomissements dans les 16 h qui ont suivi I'opEration, que celles qui ont re~u une faible dose (P < 0,05). La fr~quence cardiaque, la tension art&ielle et le rythme respiratoire n'ont pas pr&entd de diff&ence intergroupe. Conclusion : Les r&ultats sugg&ent qu'une tol&ance soudaine au fentanyl se ddveloppe aprEs l'administration peropEratoire d'une forte dose et qu'elle entra~ne, par consdquent, des douleurs postop&atoires plus intenses et une plus grande consommation de fentanyl.

The results suggest that perioperative esmolol administration during anaesthesia reduces the intraoperative use of inhalation anaesthetic and fentanyl, decreases haemodynamic responses, and reduced morphine consumption for the first 3 postoperative days.

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Purpose: To investigate prospectively the influence of patient characteristics upon, and the association of postoperative measurements with, the requirements for postoperative morphine and the assessment of resting pain and pain upon movement in Chinese patients.Methods: From January 1998 to December1999, patients receiving patient-controlled iv morphine subsequent to general anesthesia and surgery at our institute (Kaohsiung Veterans General Hospital), were enrolled in the study. Demographic data (such as gender, age, weight, height and education level) and postoperative measurements, including pain scores at rest or during movement, sedation scores and morphine consumption, were recorded.Results: In total 2,298 patients were recruited. Females consumed significantly less morphine via patient-controlled analgesia (PCA) in the first three postoperative days than was the case for males (P <0.05). Gender was the strongest predictor for postoperative morphine requirements. Postoperative pain upon movement was another effective predictor for morphine requirement (P <0.05). Age, body height, body weight, education and operation sites were not associated with morphine consumption.

In this double-blind, randomized, placebo-controlled study, we have evaluated the effect of preoperative administration of dexamethasone on postoperative vomiting and pain in 60 women undergoing general anaesthesia for major gynaecological surgery. Dexamethasone 10 mg (group D) or saline (group S) was administered i.v. in a double-blind manner during induction of anaesthesia. Postoperative pain relief was controlled with bolus doses of morphine using an i.v. patient-controlled analgesia device, and patients were assessed for incidence of vomiting, sedation score, verbal pain rating score, time to first morphine demand and morphine consumption at 4, 8, 12 and 24 h after surgery. Six patients in group D and 19 in group S experienced vomiting at least once within the 24-h postoperative period; dexamethasone was effective in reducing the overall incidence of vomiting from 63.3% to 20.0% (P < 0.01). Other variables were similar between the groups, and the influence of dexamethasone on postoperative pain was minimal.

IT neostigmine 50 microg produced postoperative analgesia lasting about seven hours with fewer side effects and better satisfaction ratings than IT morphine 300 microg.

Age and gender differences in neuropsychological and physiological responses after midazolam premedication were evident. Midazolam is effective for producing sedation and anxiolysis at a dose of 0.02 mg kg(-1), with minimal effects on cardiorespiration and oxygen saturation to patients. Dosage adjustments based on these covariates are, therefore, necessary.

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