European journal of anaesthesiology
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Randomized Controlled Trial Clinical Trial
Optimum time for neostigmine administration to antagonize vecuronium-induced neuromuscular blockade.
We followed the recovery time course in 46 patients antagonized by neostigmine (0.036 mg kg-1) at different levels of vecuronium-induced neuromuscular blockade ranging from post-tetanic count 1 to train-of-four ratio 0.4 and in 15 patients during spontaneous recovery. Non-linear regression curve fit analyses showed that the optimal time for neostigmine administration was when the first twitch in the train of four (T1) was between 1% and 10%. ⋯ To achieve the optimum effect, neostigmine must therefore be given 32.6 min plus the required time for peak effect of neostigmine (5.3-7.1 min), i.e. 37.9-39.7 min, before train-of-four ratio 0.7 is reached. During spontaneous recovery this corresponds to a T1 between 1% and 15%.
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Venous admixture as a measure of pulmonary gas exchange was studied before and during laparascopic cholecystectomy in 12 patients with normal healthy cardio-pulmonary function. After induction of anaesthesia the patients were studied by radial and pulmonary arterial catheterization and simultaneous arterial and mixed venous blood gas sampling in the horizontal, 15-20 degrees head-down and 15-20 degrees head-up tilt positions. After establishing the pneumoperitoneum (PP) by insufflation of carbon dioxide to an intraabdominal pressure level of 11-12 mmHg, the measurements were repeated in the same positions. ⋯ These changes were maintained during pneumoperitoneum and were not influenced by posture. It is suggested that alterations in the distribution of ventilation and/or lung perfusion results in a reduced venous admixture during PP without surgery. In addition, there was no indication that venous admixture is elevated as a result of laparoscopic surgery in the reversed Trendelenburg position.
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Randomized Controlled Trial Clinical Trial
Pre-emptive versus post-surgical administration of ketorolac for hysterectomy.
Seventy-seven women who underwent routine vaginal or abdominal hysterectomy were randomly allocated to receive intravenous ketorolac 30 mg either 30 min before surgical incision (pre-emptive group, n = 37), or at the end of the surgical procedure (post-surgical group, n = 40). The patients received routine post-operative care, which included morphine by patient-controlled analgesia, 1 mg per demand with a lockout of 6 min and a background infusion of 1 mg h-1. In addition, pain was assessed at 12 and 24 h using a 100 mm visual analogue scale (VAS), both at rest and on coughing. ⋯ There were no significant differences on univariate testing. Subsidiary stepwise multiple regression modelling identified age, weight, type of hysterectomy, and the timing of ketorolac administration as significant explanators of post-operative morphine consumption. A statistically significant pre-emptive analgesic effect was therefore identifiable, but the clinical significance is uncertain in relation to the other influences on post-operative analgesic requirements.
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As part of an evaluation of post-operative analgesia for craniotomy patients, a postal questionnaire was sent to 183 consultant members of the Neuroanaesthesia Society of Great Britain and Ireland, inquiring about their current practices for post-operative neurosurgical analgesia. Replies were received from 110 neuroanaesthetists in 37 different neurosurgical centres. ⋯ Post-operative analgesia for craniotomy patients is perceived as inadequate by most neuroanaesthetists, yet traditional prejudice against opioid use prevents this being remedied. We suggest that patient-controlled analgesia with morphine could be a safe alternative to codeine phosphate.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison between ketorolac and diclofenac in laparoscopic sterilization.
We compared ketorolac and diclofenac for the prevention and treatment of post-operative pain in patients undergoing laparoscopic sterilization. Fifty ASA I or II women were allocated randomly to receive either diclofenac 75 mg or ketorolac 30 mg intramuscularly 30-90 min before general anaesthesia. Pain scores were assessed half-hourly in the recovery room and then at 2 h and 4 h in the ward. ⋯ Pain at the injection site was more common after diclofenac than ketorolac (12 vs. 3, P < 0.05). In conclusion, both intramuscular diclofenac and ketorolac were relatively ineffective in controlling the pain after laparoscopic sterilization. The drugs were equally well tolerated, but more patients complained of pain at the injection site after diclofenac.