European journal of anaesthesiology
-
In vitro contracture tests for susceptibility to malignant hyperthermia (MH) were performed in 96 patients according to the protocol of the European MH Group. In addition, tests were performed with halothane 0.44 mmol l-1 and 0.66 mmol l-1, and caffeine 2 mmol l-1, each added as a single bolus dose to fresh specimens. For all tests the size of contractures were recorded, and for the diagnostic tests the halothane and caffeine threshold concentrations were determined (i.e. the minimal concentrations eliciting a contracture of 0.2 g). ⋯ We conclude that, in our laboratory, the results obtained with the two major protocols for investigation of MH susceptibility are not identical. Patients surviving fulminant MH, however, react abnormally to nearly all the tests. For validation and possibly further standardization of the tests each laboratory must investigate a large number of normal controls and as many patients surviving fulminant MH as possible.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Topical anaesthesia of the larynx: cocaine or lignocaine?
A double-blind, randomized study compared the cardiovascular responses and extubation conditions using lignocaine or cocaine for topical anaesthesia of the larynx. Absorption of both agents from the trachea was quantified by serial venous plasma concentrations. Serial blood pressure, ECG, O2 saturation and end-tidal carbon dioxide measurements were obtained. ⋯ No difference was found in cardiovascular measurements between the two groups. The patterns of absorption of cocaine and lignocaine from the laryngeal mucosa were very similar, with peak absorption occurring at 10-15 min after laryngeal spraying. Although cocaine reduced the incidence of post-operative coughing when compared with lignocaine, this did not reach statistical significance.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Dreaming and anaesthesia: total i.v. anaesthesia with propofol versus balanced volatile anaesthesia with enflurane.
Sixty consecutive ASA Grades I and II patients scheduled for elective ear, nose and throat surgery were randomly assigned to receive either total i.v. anaesthesia with propofol ('propofol group') or 'balanced technique' with thiopentone induction followed by N2O and enflurane. Patients were asked whether they had experienced dreams immediately after extubation when verbal communication was established, in the recovery room and in the ward on the evening of the day of surgery. ⋯ In the recovery room and in the ward only three patients of the propofol group (10%) and one patient in the enflurane group (3%) remembered that they had been dreaming (NS). To avoid underestimating the frequency of peri-operative dreaming, post-operative interviews should take place as soon as possible after conversing is possible.
-
Randomized Controlled Trial Clinical Trial
Effect of pre-operative metoprolol on cardiovascular and catecholamine response and bleeding during hysterectomy.
The effect of a pre-operative dose of metoprolol on the catecholamine and cardiovascular responses to tracheal intubation and surgery, cardiac complications and intra-operative blood loss, were studied in patients undergoing elective hysterectomy during general anaesthesia. The study was double-blind and placebo controlled. The patients received metoprolol 100 mg or placebo orally 1-25 h before anaesthesia. ⋯ The incidence of arrhythmias was less after metoprolol. The mean operative blood loss was greater in the placebo group (486 +/- 170 ml (SEM) compared to 231 +/- 43 ml (SEM) after metoprolol). We conclude that oral premedication with metoprolol attenuates the hypertensive response to tracheal intubation and reduces both arrhythmias and operative blood loss.