European journal of anaesthesiology
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Randomized Controlled Trial Comparative Study Clinical Trial
Continuous sedation during spinal anaesthesia: gamma-hydroxybutyrate vs. propofol.
Gamma-hydroxybutyrate (GHB) may well be developed as an alternative for optional sedation during spinal anaesthesia. As in the case of propofol (PRO), GHB has good sedative properties associated with cardiovascular and respiratory stability. When used as a narcotic agent, recovery times are variable (e.g. > 30 min); in contrast, sedative dosages, as used in intensive care patients (e.g. 10-20 mg kg-1 h-1), result in adequate clinical recovery. ⋯ Control and recovery are acceptable for clinical purposes. It seems that GHB and PRO have similar haemodynamic, respiratory and endocrinological characteristics. Therefore, GHB may serve as an alternative for the established management of continuous sedation during SPA with PRO.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of clonidine 1 microgram kg-1 with morphine 30 micrograms kg-1 for post-operative caudal analgesia in children.
In a prospective randomized study in children, we compared caudal bupivacaine-clonidine with bupivacaine-morphine to evaluate whether clonidine can be used as an alternative to morphine in caudal anaesthesia. Caudal anaesthesia was administered in 36 children undergoing orchidopexy, hernia repair or circumcision, using 1.5 mL kg-1 bupivacaine 0.18% with either 1 microgram kg-1 clonidine (group 1) or 30 micrograms kg-1 morphine (group 2). Haemodynamic and respiratory parameters, anaesthetic requirements, recovery time and pain score were monitored for 24 h. ⋯ Recovery time after anaesthesia was significantly longer in group 1 (16.6 +/- 8.8 min) than in group 2 (11.5 +/- 4.7 min) (P < 0.05). We conclude that analgesia provided by 1 microgram kg-1 clonidine added to caudal bupivacaine is comparable with that provided by 30 micrograms kg-1 caudal morphine with bupivacaine. Clonidine at this low dose did not cause respiratory depression.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of the effects of topical lignocaine spray applied before or after induction of anaesthesia on the pressor response to direct laryngoscopy and intubation.
In an attempt to attenuate the cardiovascular pressor response to laryngoscopy and intubation, 30 patients presenting for routine ophthalmic surgery were studied and were randomly allocated into two groups: group A (n = 15) received direct laryngeal/tracheal lignocaine spray immediately before intubation; and group B (n = 15) received orolaryngeal lignocaine spray before the induction of anaesthesia. In both groups, general anaesthesia was induced with thiopentone 3-5 mg kg-1, followed by atracurium 0.6 mg kg-1 to facilitate tracheal intubation. ⋯ In addition, the plasma lignocaine concentrations remained well below the toxic range in both groups. It was concluded that topical lignocaine administration as an orolaryngeal spray before the induction of anaesthesia is effective in reducing but not abolishing the pressor response to laryngoscopy and endotracheal intubation.
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Randomized Controlled Trial Clinical Trial
Granisetron reduces post-operative vomiting in children: a dose-ranging study.
This study was undertaken to determine the minimum effective dose of granisetron, 5-hydroxytryptamine type 3 receptor antagonist, for the prevention of post-operative vomiting in children undergoing general inhalational anaesthesia for surgery (inguinal hernia and phimosis). In a randomized, double-blind manner, 120 children, ASA physical status I, aged 4-10 years, were assigned to receive placebo (saline) or granisetron at three different doses (20 micrograms kg-1, 40 micrograms kg-1, 100 micrograms kg-1) intravenously immediately after inhalation induction of anaesthesia (n = 30 of each). ⋯ No clinically important adverse events were observed in any of the groups. Our results suggest that granisetron 40 micrograms kg-1 is the minimum effective dose for the prevention of emesis after paediatric surgery, and that increasing its dose to 100 micrograms kg-1 provides no demonstrable benefit.
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Randomized Controlled Trial Clinical Trial
Hypnotic endpoints vs. the bispectral index, 95% spectral edge frequency and median frequency during propofol infusion with or without fentanyl.
Hypnotic endpoints and/or EEG variables, e.g. bispectral index, 95% spectral edge frequency and median frequency, have been studied to monitor anaesthetic (hypnotic) depth during total intravenous anaesthesia. In this study, the relation between the hypnotic endpoints of unresponsiveness to verbal commands, loss of eyelash reflex and body movement response to mechanical nasal membrane stimulation vs. bispectral index, 95% spectral edge frequency and median frequency during propofol anaesthesia with or without fentanyl is presented. Forty-two patients were randomly assigned to receive either propofol infusion, 30 mg kg-1 h-1 (n = 22), or propofol infusion, 30 mg kg-1 h-1 + fentanyl bolus, 2 micrograms kg-1 i.v. (n = 20). ⋯ Doses of propofol for achieving the hypnotic endpoints were significantly lower in the propofol + fentanyl compared with the propofol group. Plasma propofol concentrations at inhibition of nasal body movement response were lower in the propofol + fentanyl compared with the propofol group (9.2 +/- 2.0 micrograms mL-1 vs. 14.1 +/- 4.2 micrograms mL-1). Our results suggest that fentanyl pretreatment potentiates the effects of propofol and achieves the hypnotic endpoints at higher bispectral index values and lower propofol doses and concentrations (measured at inhibition of nasal body movement response).