European journal of anaesthesiology
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Case Reports
Anaesthetic management for caesarean section combined with removal of phaeochromocytoma.
In this case report, the anaesthetic management for a removal of phaeochromocytoma undertaken immediately following Caesarean section is described. A 32-year-old female patients was given epidural anaesthesia for Caesarean section, and thereafter, general anaesthesia for a resection of phaeochromocytoma. ⋯ A live infant was delivered and the supra-adrenal tumour was excised successfully. The patient's post-operative recovery was uneventful.
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Randomized Controlled Trial Clinical Trial
Effective dose of granisetron for the prevention of post-operative nausea and vomiting in patients undergoing laparoscopic cholecystectomy.
This study was undertaken to determine the minimum effective dose of granisetron, a selective 5-hydroxytryptamine type 3 receptor antagonist, for the prevention of post-operative nausea and vomiting (PONV) in female patients undergoing elective laparoscopic cholecystectomy. In randomized, placebo-controlled, double-blind study, 120 women were assigned to receive either placebo (saline) or granisetron at three different doses (20 micrograms kg-1, 40 micrograms kg-1 or 80 micrograms kg-1) intravenously immediately before the induction of anaesthesia. ⋯ Adverse effects post-operatively were not different among the groups. In conclusion, granisetron 40 micrograms kg-1 is the minimum effective dose in the prevention of PONV after laparoscopic cholecystectomy.
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This case report describes the peri-operative management of a 48-year-old woman with three cerebral aneurysms and phaeochromocytoma. The pharmacological and anaesthetic management of such patients is complex, and needs to be managed carefully by titrating anaesthetic agents and vasoactive drugs. The primary concern is the maintenance of cerebral perfusion pressure and autoregulation throughout the procedure, although these states cannot be monitored directly. The patient survived the operation neurologically intact, and it is presumed that the course of management which was chosen helped to achieve this result.
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Comparative Study Clinical Trial Controlled Clinical Trial
Adsorption of desflurane from the scavenging system during high-flow and minimal-flow anaesthesia by zeolites.
Application of high-silica zeolites in a special adsorber allows complete selective adsorption of the inhalation anaesthetic desflurane from the outlet port of the scavenging system of the anaesthesia machine. In comparison with charcoal filters, zeolites allow almost complete desorption at moderate temperatures followed by condensation of the desflurane to the liquid phase. The adsorption of scavenged desflurane by zeolites was measured in 13 patients. ⋯ A minimal-flow regime (0.5 L min-1 fresh gas inflow) was used for maintenance in seven patients and a higher-flow regime (3 L min-1 fresh gas flow) was used for maintenance in six patients. In minimal-flow anaesthesia, 62% of the delivered desflurane was adsorbed by the zeolite while 86% of the delivered desflurane was adsorbed in higher-flow anaesthesia. Preliminary results show that about 85% of the adsorbed desflurane could be recovered as liquid with high purity via desorption.
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Randomized Controlled Trial Comparative Study Clinical Trial
Addition of droperidol to morphine administered by the patient-controlled analgesia method: what is the optimal dose?
Eighty patients were recruited into a double-blind, randomized trial to find the optimal dose of droperidol for addition to the patient-controlled analgesia (PCA) morphine infusate for female patients undergoing gynaecological surgery. A standardized anaesthetic technique was employed. Post-operative analgesia was provided by PCA morphine. ⋯ However, after 24 h, patients in group 4 were significantly more sedated than patients in groups 1 and 2 (P < 0.05). There were no significant differences between the groups in terms of the incidence of anxiety or other side effects attributable to droperidol. The present authors suggest that, although the results demonstrate few statistically significant differences between the four groups, a PCA bolus dose of droperidol of 0.10 mg mL-1 appears to provide the optimal balance between anti-emetic efficacy and an acceptable incidence of side effects.