The influence of anaesthetic drug selection for scoliosis surgery on the management of intraoperative haemodynamic stability and postoperative pain – pharmaceutical care programme

Abstract

Aim: The aim of this study was to conduct a pharmaceutical care programme for two different anaesthetic methods used during scoliosis surgery, to investigate which method ensured better intraoperative haemodynamic stability and postoperative pain control.
Methods: A clinical pharmacist actively participated in a prospective randomised double blind study for 40 patients who had a physical status class I-II ASA, scheduled for scoliosis surgery, who were randomly allocated into two groups, 20 in each group. Both groups received midazolam preoperatively, propofol, sevuflorane, atracurium, and either remifentanil infusion 0.2 μg/kg/min for (Group 1 = G1), or the same dose of remifentanil infusion and low dose ketamine infusion 1 μg/kg/min (Group 2 = G2), antidote medications and postoperative morphine. Patients were subject to a pharmaceutical care programme. Heart rate HR, MAP, vital signs, surgical bleeding, urine output, time to accomplish the wake up test, duration of surgery and duration of anesthesia were recorded. In postanesthesia care unit (PACU) for 24 hours, the recovery
time, the first pain score and analgesic requirements were assessed. All drugs used were documented in medical charts for statistical analysis.
Results: Intraoperative heart rate and arterial blood pressure were significantly less (p < 0.05) in G1 as compared with G2. In the (PACU) the first pain score recordings were significantly less (p < 0.05) in G2 than G1. The time which passed until the first patient analgesia demand dose was greater in G2 and morphine consumption was greater in G1 than G2 (p < 0.05). The rest of the results were not significantly different between the two groups. None of the patients had any allergic or adverse drug reaction to any of the medications.
Conclusions: Adding a low dose ketamine hydrochloride infusion during scoliosis surgery could be applied as a routine therapy to improve the haemodynamic stability during the surgery and reduce the postoperative morphine consumption. A pharmaceutical care programme tested in this study gave a high score for patient satisfaction.

Keywords: scoliosis; remifentanil; ketamine