European journal of anaesthesiology
-
From a family tragedy 20 years ago, ATLS has truly become an international trauma care program. Its success is demonstrated not only in the large number of physicians that have been trained, but also in the appearance of a number of affiliated courses with a similar structure, aimed at training medical, nursing, civilian and military personnel in how to deal with trauma in a variety of settings. ⋯ We are now faced with the next major stage in the development of ATLS, namely to provide the evidence for the efficacy of this in an acceptable scientific manner. It is a challenge we should accept with the same enthusiasm that originally embraced ATLS, and where better to meet this challenge than within the countries of Europe?
-
Comparative Study Clinical Trial
A comparison of the use of transoesophageal Doppler and thermodilution techniques for cardiac output determination.
Doppler cardiac output (CO) determination is discussed as a non-invasive alternative to CO estimation by thermodilution. This study was designed to compare the accuracy of a new transoesophageal Doppler device with the thermodilution technique. In 24 patients undergoing coronary artery bypass surgery, CO was determined simultaneously by the oesophageal Doppler (OD) and thermodilution (TD) method in triplicate for three sample episodes: after induction of anaesthesia during clinical steady-state conditions (A), after start of surgery (B), and after sternotomy (C). ⋯ Bias analysis of the log-transformed data revealed that 95% of the ODCO values differed from TDCO values by 43% below to 50% above for sample episode A, by 39% below to 95% above for sample episode B, and by 32% below to 96% above for sample episode C. Analysis of the changes in CO from sample episode A to B and from sample episode B to C, expressed as percentage values, showed a non-significant bias between the methods, but the 2 SD limits were +/-44% and +/-36% respectively. Our findings suggest that CO estimation by OD cannot replace estimation by the TD method.
-
Clinical Trial Controlled Clinical Trial
Patient-controlled epidural diamorphine for post-operative pain: verbal rating and visual analogue assessments of pain.
Twenty-two patients were studied while receiving epidural analgesia with diamorphine after major lower abdominal surgery under combined regional and general anaesthesia. Epidural PCA began when the intraoperative epidural block with bupivacaine wore off enough for the patient to request treatment. It was started with 2 mg of diamorphine and continued with a reducible background infusion that was initially set at 0.2 mg h-1 and supplemented by on-demand doses of 0.2 mg, with a lockout time of 15 min. ⋯ The plasma morphine concentrations rose to a plateau by about 15 min, with concentrations within 95% CI from 0 to 11 ng mliters-1 (average 5 ng mliters-1. The VRS and VAS pain scores were analysed by a conservative approach that treated them as ordinal data, and by a parametric approach that treated them as interval data. Both approaches conveyed broadly similar information about the post-operative analgesia.
-
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.
-
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.