European journal of anaesthesiology
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A case of thoraco-abdominal rigidity leading to respiratory failure is described in the post-operative period in an elderly patient who received a moderate dose of fentanyl. This was successfully reversed by naloxone. The mechanisms possibly implicated in this accident are discussed.
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Case Reports
Dantrolene plasma and urine concentrations after oral pretreatment for malignant hyperthermia: report of a case.
Dantrolene plasma concentrations and renal clearance calculations in a patient undergoing major surgery are reported. The family history was positive for malignant hyperthermia. Following oral pretreatment the plasma concentrations in this patient were not noticeably different from values obtained in a study in awake volunteers and which were thought to be effective. This is the first report of dantrolene measurements made during anaesthesia and in the post-operative period.
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Randomized Controlled Trial Comparative Study Clinical Trial
The influence of cyclizine and perphenazine on the emetic effect of meptazinol.
The effectiveness of 50 mg cyclizine and 2.5 mg perphenazine against the emetic sequelae of 100 mg meptazinol were studied in a randomized double-blind placebo-controlled trial. Three groups of 40 women received the opioid, together with an anti-emetic by i.m. injection, as premedication prior to minor gynaecological surgery. Beneficial or noxious effects were noted at standard time intervals and anaesthesia standardized as incremental methohexitone with nitrous oxide/oxygen. ⋯ Perphenazine, 2.5 mg, showed no useful anti-emetic effect. Both anti-emetics increased the soporific effect of premedication at the 90-min interval. Subjects receiving perphenazine experienced significantly more dizziness than those of other groups.
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Randomized Controlled Trial Comparative Study Clinical Trial
Droperidol, alizapride and metoclopramide in the prevention and treatment of post-operative emetic sequelae.
Women (182) undergoing elective orthopaedic surgery under general anaesthesia received 100 or 200 mg alizapride, 1.25 mg droperidol, 20 mg metoclopramide or a saline placebo intravenously 5-10 min before the end of anaesthesia in a double-blind random fashion to prevent post-operative nausea and vomiting. Administration of the same anti-emetic was repeated during 24 h post-operatively if the patient complained of nausea or retched or vomited. Significantly fewer patients given any of the anti-emetics prophylactically were nauseated or vomited in comparison with patients given saline. ⋯ The number of patients needing an additional dose of the same substance in the post-operative period was significantly higher in the saline group (67%) than in the groups which had received droperidol (32%, P less than 0.01) and alizapride 100 mg (37%, P less than 0.05) or 200 mg (33%, P less than 0.05). The patients who received metoclopramide, however, did not differ statistically from the saline group in the treatment of nausea and vomiting. It is concluded that droperidol was the most effective, and metoclopramide the least effective, anti-emetic in this study.
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Randomized Controlled Trial Clinical Trial
Intrathecal morphine in cardiac surgery.
The effects of intrathecal morphine in 60 patients undergoing open-heart surgery were studied in an observer-blind control trial. The patients were randomly allocated into three groups of 20 each: (A) Control, (B) 2 mg and (C) 4 mg of intrathecal morphine. This study confirms that intrathecal morphine provides useful post-operative analgesia. ⋯ Since the completion of this study, reports have suggested that 1 mg of morphine intrathecally avoids the serious complications of respiratory depression. In the study described, the patients were electively ventilated post-operatively and respiratory depression was therefore not a problem. Of the other associated side-effects of intrathecal morphine, vomiting (20%) and pruritus (20%) proved the most troublesome.