European journal of anaesthesiology
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Randomized Controlled Trial Comparative Study Clinical Trial
Anaesthesia during laparoscopic gynaecological surgery: a comparison between desflurane and isoflurane.
Desflurane is a new inhalation anaesthetic with a low blood/gas solubility which should allow a fast emergence from anaesthesia. In a prospective open randomized study, desflurane was compared with isoflurane paying special attention to recovery and the quality of the post-operative period. The occurrence of pain and post-operative nausea and vomiting (PONV) was recorded during the first 20 post-operative hours. ⋯ In both groups PONV was more frequently observed in patients after leaving the recovery room. PONV in the recovery room was associated with a delayed discharge, 139 vs. 114 min respectively. Desflurane seems to be an useful alternative to isoflurane for laparoscopic procedures.
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Randomized Controlled Trial Clinical Trial
Readiness for surgery after axillary block: single or multiple injection techniques.
We have assessed prospectively the time to readiness for surgery following axillary block (sum of block performance and latency times) in 80 patients. The brachial plexus was identified using a nerve stimulator, and anaesthetized with 45 mL of mepivacaine 1% with adrenaline 5 micrograms mL-1. In group 1 (single injection) the whole volume of mepivacaine was injected after locating only one of the plexus nerves. ⋯ The frequency of adverse effects (vessel puncture or paraesthesia) was similar in both groups. No neurological sequelae were observed. We conclude that the multiple injection technique takes longer to perform than single injection, but that readiness for surgery is faster because of shorter block latency and better spread of analgesia.
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Reports about post-operative infections associated with the use of propofol prompted us to investigate the in-use contamination of lipid-formulated intravenous (i.v.) anaesthetics used for general anaesthesia or for sedation of intensive care patients in this department. The level and incidence of extrinsic contamination of propofol ('Diprivan') and of another intravenous anaesthetic, etomidate, formulated in lipid solution ('Etomidat-lipuro') was found to be low during two study periods. However, the need to observe strict aseptic precautions in handling these intravenous drugs must be emphasized.
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Although the administration of alfentanil is routine in neurosurgical anaesthesia, the effects of the drug on cerebrospinal fluid pressure (CSFP) or intracranial pressure (ICP) have been a subject of controversy in the past. Therefore the effects of alfentanil (3 micrograms kg-1) on mean lumbar cerebrospinal fluid pressure (CSFP), heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP) and end-tidal carbon dioxide (ETCO2) in human volunteers without cerebral disease is reported here. The CSFP increased from 9 mmHg (P < 0.05) after intravenous (i.v.) injection of alfentanil, to 12 mmHg whereas MAP, CVP, HR and ETCO2 remained stable throughout the investigative period. The results from this study suggest that alfentanil, even when administered in low doses, leads to a relatively small but statistically significant increase in CSFP in humans with uncompromised intracranial compliance.