Rattanaporn Burimsittichai, Phoonsak Limraksasin, Cameron Paul Hurst and Somrat Charuluxananan
Catheter-related bladder discomfort (CRBD) is a distressing symptom after anesthesia.
To compare the efficacy of tramadol and ketamine to prevent CRBD after laparoscopic surgery.
After registration with the Thai Clinical Trial Registry (TCTR20140220001), we conducted a randomized controlled trial in 210 patients aged 18-70 years with American Society of Anesthesiologists physical status I or II undergoing elective laparoscopic surgery requiring bladder catheterization. These patients were randomly allocated into 1 of 3 groups: Group T received intravenous (i.v.) tramadol 1.5 mg/kg, Group K received i.v. ketamine 0.5 mg/kg, and Group P received i.v. saline as a placebo before catheterization. Patients received i.v. morphine for postoperative pain control. An anesthesiologist blinded to the randomization evaluated postoperative and CRBD pain severity using visual analog scales (VAS). The cumulative postoperative and CRBD pain was calculated by multiplying mean VAS scores by the hours of assessment.
Groups T and K had significantly less cumulative CRBD pain compared with placebo (P = 0.04 and 0.001, respectively). Cumulative postoperative pain, total 24-h morphine consumption, and adverse effects were comparable between groups. Group T had a significantly lower incidence of shoulder pain (7/67, 10%) than Group K (21/70, 30%), and Group P (24/70, 34%) 24 h after surgery (P = 0.006 and 0.001, respectively).
Tramadol 1.5 mg/kg and ketamine 0.5 mg/kg administered i.v. before bladder catheterization are both effective in reducing the 24-h cumulative postoperative CRBD after laparoscopic surgery without significant adverse effects. Tramadol also decreases the incidence of postlaparoscopy shoulder pain.
Passisd Laoveeravat, Nicha Wongjarupong, Chonlada Phathong, Cameron Hurst, Sombat Treeprasertsuk, Rungsun Rerknimitr and Roongruedee Chaiteerakij
Cirrhotic patients are susceptible to drug toxicity, which presents frequently with antituberculosis drug (ATD) treatment. Previous studies of ATD-induced liver injury (ATDILI) in cirrhotics have been limited to patients with early-stage cirrhosis.
To describe characteristics and determine risk factors for ATDILI in cirrhotic patients.
We included 64 cirrhotic patients treated with ATDs between 2006 and 2016 in a tertiary referral university teaching hospital in Bangkok, Thailand. Cirrhosis was diagnosed by radiological features, including small-sized nodular liver and/or caudate lobe hypertrophy or evidence of portal hypertension (collateral vessels, varices, and/or splenomegaly). Clinical information was retrospectively abstracted. Characteristics of patients with ATDILI vs. those without ATDILI were compared.
Six (9.4%) patients developed ATDILI with the median duration from ATD initiation of 14 days (range: 6–66). All the 6 patients who developed ATDILI received 3 hepatotoxic ATDs (isoniazid, rifampin, and pyrazinamide) and had Child–Turcotte–Pugh class B cirrhosis. The patients with ATDILI were found to have a higher percentage of human immunodeficiency virus (HIV) infection than patients without ATDILI (50% vs. 8.6%; P = 0.02).
Cirrhotic patients, particularly those with underlying HIV infection, are at risk of developing ATDILI. Pyrazinamide should be used cautiously in cirrhotic patients due to the significantly increased risk of ATIDLI. This study supports the current recommendation for the use of ATD in patients with cirrhosis; however, the ATD regimen should be carefully selected, particularly for cirrhotic patients with HIV infection.