European journal of anaesthesiology
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Randomized Controlled Trial Comparative Study Clinical Trial
Timing of tracheal intubation: monitoring the orbicularis oculi, the adductor pollicis or use a stopwatch?
The most suitable time for tracheal intubation, following vecuronium 0.1 mg kg-1, was estimated in 120 patients. The trachea was intubated at cessation of the visually observed response of the orbicularis oculi muscle to facial nerve stimulation (group 1; n = 30), or of the manually detected response of the adductor pollicis to ulnar nerve stimulation (group 2; n = 30), or after waiting 3 min (group 3; n = 30), or 4 min (group 4; n = 30). There were no significant differences in intubation scores between the four groups of patients. ⋯ However, intubating conditions were poor in four patients (14%) in group 1, compared with none in group 2 and one in groups 3 and 4, respectively. Thus, contrary to expectations, the cessation of the response of the orbicularis oculi muscle did not guarantee good or even satisfactory intubating conditions. The results suggest that in fit adult patients it is as good to wait 3 min after injection of vecuronium 0.1 mg kg-1 before tracheal intubation, as to use a nerve stimulator.
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Randomized Controlled Trial Clinical Trial
Intramuscular NSAIDS reduce post-operative pain after minor outpatient anaesthesia.
Two hundred healthy patients scheduled for elective minor gynaecological surgery under general anaesthesia were randomly allocated to one of four groups who received either diclofenac 75 mg intramuscularly (i.m.), ketorolac 30 mg i.m., diclofenac 50 mg orally, or 2 mL NaCl i.m. The drugs were administered 10-20 min prior to a standard anaesthetic. ⋯ Complaints about pain and need for post-operative analgesics were significantly less frequent in the two groups of patients receiving an intramuscular non-steroidal anti-inflammatory drug (NSAID), as compared to placebo. The patients who received 50 mg diclofenac orally, administered shortly before the procedure, had the same pain course as the placebo patients.
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Randomized Controlled Trial Comparative Study Clinical Trial
Nausea and vomiting after laparoscopic surgery: a comparison of propofol and thiopentone/halothane anaesthesia.
Sixty ASA I and II patients scheduled for laparoscopic cholecystectomy or inguinal herniotomy were randomly assigned to one of two groups: Group one (n = 30): induction with thiopentone 4-6 mg kg-1, fentanyl 2 micrograms kg-1, pancuronium 0.03 mg kg-1, and succinylcholine 1 mg kg-1, maintainance with halothane (0.8-1.5%), and N2O in O2 (FiO2 = 0.33). Group two (n = 30): induction with propofol 2-3 mg kg-1, fentanyl 2 micrograms kg-1, pancuronium 0.03 mg kg-1, and succinylcholine 1 mg kg-1, maintainance with propofol 6-10 mg kg-1 h-1, and O2 in N2 (FiO2:0.33). ⋯ The overall incidence of emetic sequelae (nausea or vomiting) was 43% in group one and 23% in group two (P = 0.17). Patients with propofol anaesthesia had lower emetic scores and higher recovery scores compared with those after thiopentone/halothane anaesthesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Post-operative intravenous continuous analgesia: comparison of buprenorphine, fentanyl and nalbuphine.
Continuous intravenous infusions of fentanyl, buprenorphine or nalbuphine were investigated to provide pain relief for patients after major abdominal surgery. Buprenorphine (n = 23) was given as a loading dose of 5 micrograms kg-1 and infused at 0.8 micrograms kg-1 h-1. Fentanyl (n = 20) was given as a loading dose of 2 micrograms kg-1 and infused at 0.7 micrograms kg-1 h-1. ⋯ The infusion rate was increased when analgesia was inadequate, and decreased if respiratory depression occurred. Mean doses were respectively 0.74 +/- 0.15 microgram kg-1 h-1 buprenorphine, 0.68 +/- 0.18 microgram kg-1 h-1 fentanyl, 83 +/- 21 micrograms kg-1 h-1 nalbuphine. Titration of continuous intravenous infusion of buprenorphine and fentanyl provided better analgesia than nalbuphine with smaller doses than those reported in similar studies allowing spontaneous breathing.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison between total intravenous anaesthesia using a propofol/alfentanil mixture and an inhalational technique for laparoscopic gynaecological sterilization.
Thirty patients undergoing laparoscopic gynaecological sterilization, as day-cases, were randomly allocated to receive either total intravenous anaesthesia (TIVA) with a propofol and alfentanil mixture or a standard inhalational technique. Immediate recovery, as measured by times to awakening, co-operation and orientation, and psychomotor recovery, as measured by 'P' deletion studies, were not significantly different between the two groups. ⋯ There were no differences between the two groups with respect to suitability for discharge home and no incidences of awareness. We conclude that TIVA with a propofol and alfentanil mixture provides satisfactory anaesthesia for gynaecological sterilization, with good recovery characteristics and a low incidence of post-operative nausea and vomiting.