European journal of anaesthesiology
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Randomized Controlled Trial Comparative Study Clinical Trial Controlled Clinical Trial
Fentanyl and bupivacaine mixture for extradural blockade in orthopaedic surgery: effects on haemodynamic responses and pain related to the use of thigh tourniquet.
Analgesic and haemodynamic changes due to tourniquet application were investigated in a prospective double-blind study on orthopaedic patients submitted to extradural lumbar blockade with a bupivacaine and fentanyl mixture. The study was carried out in 161 healthy patients undergoing limb surgery with a thigh tourniquet. Patients were randomly assigned to two groups: each group received treatment with bupivacaine 0.5% containing 1:200,000 adrenaline. ⋯ A dramatic reduction in intra-operative supplemental analgesic needs was observed in the B:F 200 group. This group of patients also complained less of tourniquet pain than their counterparts, for the first 30 min of application. Our study underlines the value of fentanyl addition to bupivacaine in extradural blockade in orthopaedic surgery.
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Randomized Controlled Trial Comparative Study Clinical Trial
Post-operative morbidity associated with the use of atracurium and vecuronium in day-case laparoscopy.
Patients were randomly allocated to receive either vecuronium or atracurium as the sole muscle relaxant for day-case gynaecological laparoscopy to determine if either agent was superior with respect to post-operative morbidity during the 48 h after operation. Intubating conditions and cardiovascular stability were similar in both groups. ⋯ There was no statistical difference in specific morbidity during the 48 h after laparoscopy, but a greater number of patients in the vecuronium group was able to resume normal activity 24 h after laparoscopy. Both agents are very suitable for day-case laparoscopies and other short surgical procedures.
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We studied whether long-term epidural catheter (nylon) placement for bupivacaine administration (morphine in 2 pigs) would cause any pathological changes in the epidural space and spinal cord of pigs. There were similar kinds of slight inflammatory changes in ligamentum flavum and dura mater in bupivacaine-treated (4 ml 0.5% bupivacaine, twice daily for 7 days, n = 8; 16 ml 0.25% bupivacaine infusion in 12 h, n = 3) and morphine-treated (2 mg preservative-free morphine, twice daily for 7 days, n = 2) pigs compared with corresponding control pigs (saline, n = 8) 24 h after treatment. There were minimal inflammatory changes in one of the two bupivacaine-treated pigs recovering for 3 weeks. ⋯ In this pig the overall level of bupivacaine plasma concentrations after an injection decreased stepwise during the 7-day period (sampling at 2-day intervals). In the other pigs treated for 7 days, the level of bupivacaine concentrations did not change markedly from first sampling to later samplings. It is probable that inflammatory changes in the epidural space, following prolonged administration of bupivacaine and morphine, are largely due to catheter irritation.
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To evaluate respiratory drive and timing in 11 spontaneously breathing infants anaesthetized with halothane, ventilation was followed before and during CO2 provocation, and occlusion tests were performed. All infants were younger than 6 months of age and their weights ranged from 3.8 to 7.5 kg. All measurements were performed prior to surgery. ⋯ The net effect of increased inspiratory drive during CO2 breathing resulted in a VT which on average was increased by 67% (P less than 0.001) so that the mean value of E'CO2 only rose by 0.98% (P less than 0.01) from 5.18% before to 6.16% during CO2 breathing. It was concluded that ventilatory compensation to CO2 was adequate, indicating preserved respiratory centre activity. Respiratory timing, however, was unaffected by CO2 indicating a discrepancy between the effects of halothane on respiratory motor centre activity and the bulbopontine pacemaker in these young infants.
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Randomized Controlled Trial Comparative Study Clinical Trial Controlled Clinical Trial
The effect of atracurium, vecuronium and pancuronium on heart rate and arterial pressure in normal individuals.
Heart rate and rhythm (from ECG) and systolic, diastolic and mean arterial pressures (using an oscillotonometer) were measured for 30 min following administration of atracurium 0.5 mg kg-1 (n = 20), vecuronium 0.1 mg kg-1 (n = 20) or pancuronium 0.1 mg kg-1 (n = 20) during steady-state anaesthesia, with nitrous oxide, oxygen and either 0.75% halothane or fentanyl 4-5 micrograms kg-1, in the absence of any surgical stimulation. Whereas atracurium and vecuronium were associated with only small and clinically unimportant changes in heart rate, pancuronium produced a marked and significant increase associated with a junctional rhythm in four patients. ⋯ No serious bradycardias were observed with either atracurium or vecuronium. Five patients showed cutaneous signs of histamine liberation after administration of atracurium.