European journal of anaesthesiology
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Randomized Controlled Trial Clinical Trial
Visual evaluation of train-of-four and double burst stimulation, fade at various currents, using a rubber band.
The sensitivity of train-of-four (TOF) or double burst stimulation3,3 (DBS3,3) was examined to detect fade by visual inspection, at varying stimulating currents, using the thumb of the investigated arm maintained abducted by the use of a rubber band. One-hundred adult patients were allocated randomly to (1) train-of-four-rubber band (TOF-RB), (2) train-of-four-control (TOF-control), (3) double burst stimulation-rubber band (DBS-RB), or (4) double burst stimulation-control (DBS-control) group. Each group contained 25 patients. ⋯ In contrast, when measured TOF ratio was 0.51-0.80, at the stimulating current of 50 or 30 mA, the likelihood of visual detection of fade in the DBS-RB group was significantly higher than in the DBS-control group (P < 0.05). With a TOF ratio of 0.61-0.70, in the DBS-RB group the probability of visual detection of fade at 50 or 30 mA was significantly higher than at 20 mA (P < 0.05). This study suggests that when using a rubber band, fade in response to the DBS3,3 is detected by visual inspection more readily at a stimulating current of 50 or 30 mA than without the rubber band.
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Randomized Controlled Trial Clinical Trial
Nitrous oxide inhalation as an adjunct to intravenous induction of general anaesthesia with propofol for day surgery.
Fifty patients were randomly allocated to receive either a preinduction inhalation with nitrous oxide (50%) in oxygen or fentanyl with preoxygenation, before induction of anaesthesia with propofol. Both groups of patients showed a significant rise in arterial oxygen saturation prior to propofol induction which established similar depths of anaesthesia, determined by the acceptability of the laryngeal mask placement. ⋯ Reduction in arterial blood pressure was also more rapid in the fentanyl group compared with the nitrous oxide group. Preinduction inhalation of nitrous oxide (50%) in oxygen appears to be an effective and acceptable method of preoxygenating the patient and augmenting the propofol induction of anaesthesia.
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Fifteen patients undergoing elective thoracic surgery were studied in order to investigate the efficacy of high frequency jet ventilation of the non-dependent lung with respect to arterial oxygenation. During the study PaO2, PaCO2, arterial pressures and heart rate were recorded during ventilation of both lungs in the lateral decubitus position during one-lung ventilation and during high frequency jet ventilation of the non-dependent lung. Mean PaO2 was 28 +/- 8.75 kPa and mean PaCO2 was 5.4 +/- 0.7 kPa during control. ⋯ With high frequency jet ventilation to the non-dependent lung, mean PaO2 increased to 25 +/- 6.75 kPa and PaCO2 decreased to 5.16 +/- 0.9 kPa respectively. Arterial pressures and heart rate remained stable during the study period. In conclusion high frequency jet ventilation of the non-dependent lung was effective in providing arterial normoxaemia and normocapnia during one-lung ventilation.
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Randomized Controlled Trial Comparative Study Clinical Trial
Attenuation of the haemodynamic responses to noxious stimuli in patients undergoing cataract surgery. A comparison of magnesium sulphate, esmolol, lignocaine, nitroglycerine and placebo given i.v. with induction of anaesthesia.
A study was conducted on 100 middle-aged to elderly patients (n = 52, healthy; n = 48, suffering from either diabetes, hypertension, ischaemic heart disease or a combination of these diseases) undergoing cataract extraction to assess the effects of laryngoscopy and tracheal intubation, anaesthesia and surgery, eye bandaging and tracheal extubation, saline (control), magnesium sulphate 40 mg kg-1, esmolol 4.0 mg kg-1, lignocaine 1.5 mg kg-1 and glyceryl trinitrate 7.5 micrograms kg-1 given i.v. at induction of anaesthesia on heart rate (HR), blood pressure (BP), rate-pressure product (RPP) and pressure-rate quotient (PRQ). Anaesthesia was standardized. Haemodynamic responses and requirements for atropine, ephedrine and labetalol to maintain HR and BP during surgery were similar in healthy and diseased patients, and in the test drug groups. ⋯ Glyceryl trinitrate prevented a rise in BP, but was associated with tachycardia and a fall in PRQ to < 1.0. Magnesium sulphate and lignocaine did not prevent responses to laryngoscopy and tracheal intubation, and were associated with rises in RPP. Application of the eye dressing and tracheal extubation at the end of surgery each caused significant increases in HR, BP and RPP in all groups.
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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.