P Pu ur rp po os se e: : To evaluate the comparative preemptive effects of gabapentin and tramadol on postoperative pain and fentanyl requirement in laparoscopic cholecystectomy.M Me et th ho od ds s: : Four hundred fifty-nine ASA I and II patients were randomly assigned to receive 300 mg gabapentin, 100 mg tramadol or placebo in a double-blind manner two hours before laparoscopic cholecystectomy under general anesthesia. Postoperatively, patients' pain scores were recorded on a visual analogue scale every two hours for the initial 12 hr and thereafter every three hours for the next 12 hr. Patients received fentanyl 2 µg·kg -1 intravenously on demand. The total fentanyl consumption for each patient was recorded.R Re es su ul lt ts s: : Patients in the gabapentin group had significantly lower pain scores at all time intervals (2.65 ± 3.00, 1.99 ± 1.48, 1.40 ± 0.95, 0.65 ± 0.61) in comparison to tramadol (2.97 ± 2.35, 2.37 ± 1.45, 1.89 ± 1.16, 0.87 ± 0.50) and placebo (5.53 ± 2.22, 3.33 ± 1.37, 2.41 ± 1.19, 1.19 ± 0.56). Significantly less fentanyl was consumed in the gabapentin group (221.16 ± 52.39 µg) than in the tramadol (269.60 ± 44.17 µg) and placebo groups (355.86 ± 42.04 µg; P < 0.05). Sedation (33.98%), nausea/retching/vomiting (24.8%) were the commonest side effects in the gabapentin group whereas respiratory depression (3.9%) was the commonest in the tramadol group and vertigo (7.8%) in the placebo group. C Co on nc cl lu us si io on n: : Preemptive use of gabapentin significantly decreases postoperative pain and rescue analgesic requirement in laparoscopic cholecystectomy. (2,65 ± 3,00; 1,99 ± 1,48; 1,40 ± 0,95; 0,65 ± 0,61) que ceux du groupe tramadol (2,97 ± 2,35; 2,37 ± 1,45; 1,89 ± 1,16; 0,87 ± 0,50) ou placebo (5,53 ± 2,22; 3,33 ± 1,37; 2,41 ± 1,19; 1,19 ± 0,56). La demande de fentanyl a été significativement plus basse avec la gabapentine (221,16 ± 52,39 µg) qu'avec le tramadol (269,60 ± 44,17 µg) ou le placebo (355,86 ± 42,04 µg; P < 0,05). La sédation (33,98 %), les nausées/haut-lecoeur/vomissements (24,8 %) ERIPHERAL tissue injury provokes peripheral sensitization (a reduction in the threshold of nociceptor afferent peripheral terminals) and central sensitization (an activity dependent increase in the excitability of spinal neurons). 1,2 These changes contribute to the postinjury pain hypersensitivity state which manifests as an increase in the responsiveness to noxious stimuli and a decrease in the pain threshold, both at the site of injury and in the surrounding uninjured tissue. 1,2 The optimal form of treatment is that applied pre, intra and postoperatively to preempt the establishment of pain hypersensitivity during and after surgery. The preemptive treatment could be directed at the periphery, at inputs along sensory axons, and at central neurons. Different treatment regimens could be used at different times relative to surgery to maximize the prevention of pain in response to different levels of sensory inputs. 1,2 Gabapentin and tramadol both have demonstrated analgesic effect...

We evaluated the optimal preemptive dose of gabapentin for postoperative pain relief after single-level lumbar diskectomy and its effect on fentanyl consumption during the initial 24 hours in a randomized, double-blinded, placebo-controlled study in 100 patients with American Society of Anesthesiologists physical status I and II. Patients were divided into five groups to receive placebo or gabapentin 300, 600, 900, or 1200 mg 2 hours before surgery. After surgery, patients were transferred to the postanesthesia care unit (PACU). A blinded anesthesiologist recorded the pain scores at time points of 6, 12, 18, and 24 hours in the PACU on a Visual Analog Scale (VAS; 0-10 cm) at rest. Patients received patient-controlled analgesia (fentanyl 1.0 mug/kg on each demand with lockout interval of 10 minutes); total fentanyl consumption during initial 24 hours was recorded. Data were entered into the statistical software package SPSS 9.0 for analysis (one-way analysis of variance and Student-Newman-Keuls test). Patients who received gabapentin 300 mg had significantly lower VAS score at all time points. They consumed less fentanyl (patients who received placebo processed 1217.5 +/- 182.0 versus 987.5 +/- 129.6 mug; P < 0.05). Patients who received gabapentin 600, 900, and 1200 mg had lower VAS scores at all time points than patients who received gabapentin 300 mg (P < 0.05). Increasing the dose of gabapentin from 600 to 1200 mg did not decrease the VAS score, nor did the increasing dose of gabapentin significantly decrease fentanyl consumption (702.5, 635, and 626.5 microg). Thus, gabapentin 600 mg is the optimal dose for postoperative pain relief following lumbar diskectomy.

Preemptive gabapentin 300 mg po significantly decreases the severity of pain postoperatively in patients who undergo single-level lumbar discoidectomy.

IV lidocaine is effective in suppressing the cough reflex of tracheal intubation, extubation, bronchography, bronchoscopy, and laryngoscopy. We investigated this effect of lidocaine on fentanyl-induced cough in 502 patients of ASA physical status I and II scheduled for elective surgery. The patients were assigned to 2 equal groups to receive either lidocaine 1.5 mg/kg or placebo (0.9% saline) over 5 s 1 min before the administration of fentanyl 3 mug/kg in a randomized and double-blind fashion. Coughs were classified as coughing and graded as mild (1-2), moderate (3-4), or severe (5 or more). The results of the study suggest that IV lidocaine 1.5 mg/kg, when administered 1 min before fentanyl, is significantly effective in suppressing fentanyl-induced cough compared to placebo (0.9% saline) (218 versus 165 patients) (P < 0.002) but without affecting the severity of cough (P > 0.05).

No abstract

Algorithmic impact assessments (AIAs) are an emergent form of accountability for organizations that build and deploy automated decision-support systems. They are modeled after impact assessments in other domains. Our study of the history of impact assessments shows that "impacts" are an evaluative construct that enable actors to identify and ameliorate harms experienced because of a policy decision or system. Every domain has different expectations and norms around what constitutes impacts and harms, how potential harms are rendered as impacts of a particular undertaking, who is responsible for conducting such assessments, and who has the authority to act on them to demand changes to that undertaking. By examining proposals for AIAs in relation to other domains, we find that there is a distinct risk of constructing algorithmic impacts as organizationally understandable metrics that are nonetheless inappropriately distant from the harms experienced by people, and which fall short of building the relationships required for effective accountability. As impact assessments become a commonplace process for evaluating harms, the FAccT community, in its efforts to address this challenge, should A) understand impacts as objects that are co-constructed accountability relationships, B) attempt to construct impacts as close as possible to actual harms, and C) recognize that accountability governance requires the input of various types of expertise and affected communities. We conclude with lessons for assembling cross-expertise consensus for the co-construction of impacts and building robust accountability relationships.

A cell-free extract, prepared from Aspergillus parasiticus ATCC 15517 grown in synthetic medium, was active in converting L'4C]sterigmatocystin into aflatoxin B, in the presence of reduced nicotinamide adenine dinucleotide phos

A, the RSA should be 0.9 if labeling is the same as that expected from averufin (Lin et al., 1973). In our experiments the quite low RSA for aflatoxin made from acetate (0.007) compared to the relatively high RSA (0.475) for aflatoxin made from the labeled versicolorin A pigment offers additional strong evidence that this pigment is incorporated essentially intact and is not broken down into acetate units before incorporation into aflatoxin . report 45-58% conversion of sterigmatocystin to aflatoxin and conclude that sterigmatocystin or a closely related metabolite is an intermediate in the biosynthesis of aflatoxins. The 46% conversion of versicolorin A to aflatoxin found in our experiments suggests that this pigment is as efficiently converted to aflatoxin as is sterigmatocystin and offers experimental proof to the theory hypothesized by Heathcote et al. (1973) in which they propose versicolorin A as a precursor to aflatoxin .