European journal of anaesthesiology
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of omeprazole with cimetidine for prophylaxis of acid aspiration in elective surgery.
Gastric pH and volume were measured in four groups of 15 patients scheduled for elective surgery. The patients were randomly allocated to receive either no antacid, oral omeprazole 40 mg the evening before surgery, oral omeprazole 40 mg 2 h before surgery, or effervescent cimetidine 800 mg, 2 h before surgery. Anaesthesia was induced with thiopentone (4-6 mg kg-1), fentanyl (0.03 mg kg-1) and vecuronium (0.1 mg kg-1) and maintained with nitrous oxide in oxygen (50/50) and isoflurane. ⋯ Gastric pH were significantly higher in the three treated groups than in control (P < 0.01). Omeprazole and cimetidine were equally effective in reducing volume and pH of the gastric juice at the beginning and at the end of anaesthesia. Nevertheless 14.2 and 28.5% of patients who received omeprazole respectively the day before or the morning of surgery remained at risk of aspiration pneumonitis (gastric pH < 2.5 and gastric volume > 25 ml).
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Comparative Study
Blood volume at the onset of hypotension during TURP performed under epidural anaesthesia.
An analysis was made of the development of hypotension in the course of 60 transurethral resections of the prostate (TURP) performed under epidural anaesthesia. Hypotension was defined as a decrease in the systolic pressure down to 85 mmHg or less, or a total drop of 60 mmHg or more within 15 min. Indirect estimations of the blood volume according to the haemoglobin dilution method indicated that patients who developed hypotension from the epidural anaesthesia had a larger decrease in blood volume than other patients. ⋯ Low central venous pressures, which were measured in 30 of the patients, were also associated with hypotension during and after TURP. There was a significant linear relationship between the total changes in blood volume and CVP measured at the end of each 10-min period of TURP (P < 0.001). However, no correlation between heart rate and hypotension was found.
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Comparative Study
Neonatal wellbeing after elective caesarean delivery with general, spinal, and epidural anaesthesia.
A comparison was made of the acid-base and Apgar status of neonates following general (n = 34), spinal (n = 28) and epidural (n = 23) anaesthesia for elective caesarean section. Neonates delivered following spinal anaesthesia were more acidaemic (pH = 7.249) (P < 0.05) than those delivered following epidural (pH = 7.291) or general anaesthesia (pH = 7.296) despite measures taken to minimize hypotension. ⋯ The difference between epidural and general anaesthesia was significant (P < 0.05). Using these two measures of neonatal wellbeing, epidural anaesthesia provided the most favourable outcome.
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This article describes a model designed to measure the forces acting on a fibrescope when it is pushed through an endotracheal tube. Lubrication with either silicone or normal saline leads to a reduction in friction forces. Fibrescopes lubricated with normal saline require a larger force to be advanced through endotracheal tubes when compared to silicone; however, the difference is clinically unimportant and is outweighed by the advantageous properties of normal saline. A theoretical model is presented which is in close agreement with experimentally derived data.
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Randomized Controlled Trial Clinical Trial
Effects of acupuncture and transcutaneous stimulation analgesia on plasma hormone levels during and after major abdominal surgery.
The effects of acupuncture and transcutaneous electrical stimulation (TES) on plasma adrenaline (A) and noradrenaline (NA), adrenocorticotropic hormone (ACTH), beta-endorphin (beta E), anti-diuretic hormone (ADH) and hydrocortisone (cortisol) were evaluated during and, for four days after surgery in 42 male patients submitted to a standardized major abdominal operation in a comparative study of three different anaesthetic techniques. Group 1 received acupuncture and transcutaneous stimulation as the main non-pharmacological analgesic during surgery. Group 2 received moderate-dose fentanyl (initial bolus of 10 micrograms kg-1 followed by continuous infusion of 5 micrograms kg-1 h-1 for the first hour, and then 4 micrograms kg-1 h-1. ⋯ Group 3). It is concluded that acupuncture and TES have no effect on the cardiovascular response to laryngoscopy and intubation. They can replace moderate-dose fentanyl anaesthesia in major abdominal surgery at the cost of a more enhanced per-operative neuroendocrine stress response, which does not, however, influence the postoperative hormonal profiles nor the rapidity of return to pre-operative values.