Anaesthesia and intensive care
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Anaesth Intensive Care · Dec 1999
Randomized Controlled Trial Clinical TrialPharmacokinetics of paracetamol in adults after cardiac surgery.
The pharmacokinetics of paracetamol in adults after cardiac surgery have not been described. Twenty patients were randomized to receive either paracetamol 2 g through a nasogastric tube and as a suppository eight hours later or vice versa. Arterial blood samples were taken at 0.5, one, two, four, six and eight hours after dosing. ⋯ Absorption after nasogastric administration was slow compared to healthy adults (Tabs 0.06 to 0.7 h) and the bioavailability was half that expected, due to nasogastric loss. Parameter estimates had large variability. Paracetamol is unlikely to have useful clinical impact in the majority of patients when standard doses (6 g/day) are given on day 1 after cardiac surgery.
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Anaesth Intensive Care · Dec 1999
Randomized Controlled Trial Comparative Study Clinical TrialPropofol-thiopentone admixture: recovery characteristics.
We have investigated, in a prospective double-blind study, recovery from anaesthesia induced by two admixtures of propofol and thiopentone and compared it with a third group of patients who received propofol and lignocaine. Ninety unpremedicated ASA 1 or 2 patients scheduled for elective gynaecological laparoscopy as a daycase procedure were randomly allocated to receive one of three different mixtures for induction of anaesthesia as part of a standardized anaesthetic: Group P50: propofol 1% 10 ml/thiopentone 2.5% 10 ml, Group P75: propofol 1% 15 ml/thiopentone 2.5% 5 ml, Group P100: propofol 1% 20 ml/lignocaine 1% 4 ml. Recovery from anaesthesia was assessed for up to four hours post-induction by critical flicker fusion threshold and best post-box toy completion time. ⋯ Nor was there any difference between the groups with respect to postoperative analgesia or anti-emetic administration. Utilizing the most sensitive end-point, a sample of nearly 1000 patients in each group would be required to confirm the observed difference with a power of 0.8 based on the data from this study. In comparison with lignocaine, the addition of thiopentone to propofol does not delay recovery from anaesthesia and does not increase postoperative analgesic or anti-emetic requirements.
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Anaesth Intensive Care · Dec 1999
Randomized Controlled Trial Comparative Study Clinical TrialA prospective randomized clinical assessment of a new pigtail central venous catheter in comparison with standard alternatives.
The Cook Pigtail central venous catheter (CVC) has been designed to diminish the risk of vascular perforation and consequent cardiac tamponade. With the participation of 12 consultant anaesthetists and 19 registrars, adults undergoing elective surgery were randomized to receive either a Pigtail (n = 101) or their consultant anaesthetists' "standard" CVC (n = 102). Median ease of insertion was rated 8 for Pigtail CVCs and 9 for standards (10 being best; P = 0.001). ⋯ No significant difference was found in insertion time or radiographically assessed tip depth for standard and Pigtail central venous catheters. A perforated right atrium of uncertain cause occurred in a patient who received an Arrow triple-lumen central venous catheter. Participating consultant anaesthetists preferred their "standard" central venous catheter for routine use, but five indicated that they would select a Cook Pigtail where long-term use was planned because of in vitro evidence of its greater safety.
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Anaesth Intensive Care · Dec 1999
Randomized Controlled Trial Comparative Study Clinical TrialA comparison of the reinforced and standard laryngeal mask airway: ease of insertion and the influence of head and neck position on oropharyngeal leak pressure and intracuff pressure.
We conducted a randomized, crossover study of 60 paralysed anaesthetized adult patients to compare ease of insertion for the reinforced (RLMA) and standard laryngeal mask airway (LMA). We also test the hypothesis that oropharyngeal leak pressure (OLP) and intracuff pressure (ICP) vary with head and neck position for the two devices. OLP and ICP were documented in four head and neck positions (neutral first, then flexion, extension and rotation in random order) for each device. ⋯ We conclude that ease of insertion is similar for the RLMA and LMA. OLP is higher with head/neck flexion and lower with extension for both devices and is associated with a similar change in ICP. We recommend assessing the efficacy of seal for all head and neck positions likely to be encountered prior to the start of surgery.
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Anaesth Intensive Care · Dec 1999
Randomized Controlled Trial Comparative Study Clinical TrialA comparison of patient controlled epidural pethidine versus single dose epidural morphine for analgesia after caesarean section.
This double-blind, randomized study of analgesia after caesarean section compared patient controlled epidural analgesia with pethidine (15 mg of a 0.25% solution and a 10 minute lockout period) versus a single bolus of epidural morphine 4 mg. Data were collected on 78 patients at 2, 6, 8, and 24 hours postoperatively and analysed using the Wilcoxon rank sum test. ⋯ The incidence of pruritus (P < 0.001) was lower in the pethidine group at 2, 6, and 8 hours, with no difference by 24 hours. Therefore PCEA pethidine provides a useful alternative to single-dose morphine after caesarean section, particularly in those patients who have suffered severe morphine-induced pruritus previously.