European journal of anaesthesiology
-
Randomized Controlled Trial Comparative Study Clinical Trial
Total intravenous anaesthesia with sufentanil-midazolam for major abdominal surgery.
Haemodynamic and endocrine stress responses were compared during total intravenous anaesthesia with sufentanil and midazolam or fentanyl and midazolam in patients undergoing elective major abdominal surgery. Twenty-two ASA I and II patients were allocated randomly to receive sufentanil (induction 1.5 micrograms kg-1 plus infusion 1.5 micrograms kg-1 h-1) or fentanyl (induction 10 micrograms kg-1 plus infusion 10 micrograms kg-1 h-1) supplemented with 0.15 microgram kg-1 sufentanil or 1 microgram kg-1 fentanyl as necessary. Midazolam was infused to obtain plasma concentrations of 500-600 ng ml-1. ⋯ Cortisol, glucose and lactate concentrations increased in both groups. Bradycardia occurred in four patients with sufentanil and in three with fentanyl. There were two cases of marked thoracic rigidity with sufentanil and one with fentanyl.
-
Propofol has been reported to cause discolouration of urine and hair. A case of green discolouration of the liver is reported in a 56-year-old man after long-term sedation with propofol in the intensive care unit. After discontinuation of propofol the discolouration of the liver disappeared. This phenomenon is due to metabolism of propofol which may lead to a phenolic green chromophore which is conjugated in the liver and excreted in the urine.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Technical problems and side effects associated with continuous intrathecal or epidural post-operative analgesia in patients undergoing hip arthroplasty.
Fifty-five patients undergoing hip arthroplasty under spinal anaesthesia (4 ml of 0.5% plain bupivacaine) were randomized to receive post-operative analgesia either using an intrathecal or an epidural catheter. Associated technical problems and side effects were studied. In both groups per-operative analgesia was achieved with intrathecal 0.5% plain bupivacaine, 4 ml. ⋯ The number of side effects was 21 in the remaining spinal group (n = 20) and 18 in the 20 epidural group patients with successful infusions. One patient in the spinal catheter group developed postdural puncture headache. For post-operative pain relief the patients in the epidural group needed less supplementary intramuscular oxycodone (five doses/four patients) than the spinal group (17 doses/nine patients) (P < 0.05).
-
Randomized Controlled Trial Clinical Trial Controlled Clinical Trial
Neuromuscular and cardiovascular effects of neostigmine and methyl-atropine administered at different degrees of rocuronium-induced neuromuscular block.
The neuromuscular and cardiovascular effects of neostigmine, 40 micrograms kg-1, and methyl-atropine, 7 micrograms kg-1, administered at different degrees of rocuronium-induced (600 micrograms kg-1) neuromuscular block were evaluated. In one group of patients spontaneous recovery was awaited (Group A; n = 20). Neostigmine and methyl-atropine were administered 2 minutes after rocuronium (Group B; n = 20) or at 25% twitch recovery (Group C; n = 20). ⋯ The initial rate of recovery (time until a TOF ratio of 0.2) in group B, i.e. 14.2 (4.5) [12.1-16.3] min, was significantly faster than in group C, i.e. 28.7 (5.3) [26.3-31.1] min. However, the time until clinically sufficient recovery (time until a TOF ratio of 0.7) was similar for groups B, i.e. 29.3 (9.5) [24.9-33.7] min and group C, i.e. 31.8 (5.6) [29.2-34.4] min, both significantly different from that of group A, i.e. 53.2 (14.5) [46.5-59.9] min. The increase in heart rate following neostigmine/methyl-atropine was more pronounced in the group reversed at 2 min after rocuronium (P < 0.01).
-
Comparative Study
Attendance of the anaesthesiologist to the patient. National recommendations for standard of anaesthetic practice.
The national recommendations for standard of anaesthetic practice in six countries of the European Community are compared with respect to the attendance of the anaesthesiologist to the patient. These standards apply to anaesthesia, major regional anaesthesia and sedation administered by anaesthesiologists. The attendance to the patient varies from strict continuous presence of the anaesthesiologist to observation of the patient by a non-medical assistant and the anaesthesiologist taking care of another anaesthetized patient. Items which all standards should mention are defined.