European journal of anaesthesiology
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The accuracy of the Hemocue, a portable haemoglobinometer, was tested on 29 patients undergoing open-heart surgery, and the results were compared with the haemoglobin values obtained from the hospital laboratory. Special attention was paid to the lower range of haemoglobin values and the simplicity and speed of operating the meter. The correlation between the methods was good (r = 0.965). The limits of agreement were 0.0323 +/- 0.705 mmol l-1 (95% confidence level).
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Fifty consecutive patients were studied prospectively to assess the effects of a continuous intravenous infusion of midazolam hydrochloride for sedation in patients requiring intensive care. Patient comfort was acceptable in all patients. However, to maintain the same degree of sedation it was necessary to increase the daily dose of midazolam indicating that benzodiazepine tolerance may have been developing. ⋯ Two patients with combined hepatic and renal failure took 124 and 140 h to awaken. Continuous intravenous infusion of midazolam offers good patient comfort but increasing dose requirements in critically ill patients may lead to drug accumulation and delayed awakening. The risks of cumulation may be increased if the drug is given by continuous infusion for prolonged periods without intermittent assessment of the patient's conscious state.
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SPINA is a program developed with LOTUS 1-2-3 that simulates the pharmacokinetics of an infusion of intravenous anaesthetic drugs. SPINA incorporates a database which contains records of multiple-compartment pharmacokinetic models. The models have been obtained from the literature. ⋯ To perform the pharmacokinetic simulation, the anaesthetist has to choose a pharmacokinetic model in which the program determines the turn-over rates, and displays a sequence of infusion steps. On request, SPINA provides the graphs for the theoretical drug distribution and for the infusion rate required to maintain the target concentration. SPINA therefore allows one to simulate the administration of intravenous anaesthetic drugs and to optimize their delivery.
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Randomized Controlled Trial Clinical Trial
Oral controlled-release morphine and gut function: a study in volunteers.
The effects of a single 30-mg tablet of oral controlled-release (OCR) morphine (MST) on gastric emptying and small-intestine transit time (SITT) were compared with placebo in a double-blind, cross-over trial, on ten healthy volunteers. Gastric emptying was measured by paracetamol absorption and SITT by the rise in breath hydrogen after a carbohydrate test meal. There was no alteration in the absorption of paracetamol given 90 min after OCR administration but this was well before peak plasma morphine levels occurred. ⋯ Mean SITT in controls was 300 min (range 120-460 min) which was significantly prolonged in eight of the 10 subjects (P less than 0.05) and beyond the study period of 480 min in six subjects. Further study is required to determine how this compares with intramuscular morphine. Peak blood levels of morphine occurred at 3 h with a mean plasma concentration of 12.3 micrograms l-1 (SEM 2.0 micrograms l-1).
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of two sedation techniques for neuroradiology.
Two groups of 25 patients were sedated during neuroradiological investigation. The first group was sedated with fentanyl and midazolam while the other was given fentanyl and a two-stage infusion of propofol in a subanaesthetic dose. Both techniques resulted in satisfactory sedation and recovery, although those who received propofol were more likely to recall their journey from the X-ray department back to the ward. Sedation in both groups resulted in unacceptable PaO2 values in some patients which could subsequently be corrected by administration of supplementary oxygen.