The Journal of international medical research
-
Randomized Controlled Trial
Efficacy and safety of an intra-operative intra-articular magnesium/ropivacaine injection for pain control following total knee arthroplasty.
Eighty patients with osteoarthritis who underwent unilateral total knee arthroplasty were randomly assigned to two groups: the trial group received an intra-operative intra-articular injection of magnesium sulphate and ropivacaine, and the control group received an injection of normal saline. All patients received patient-controlled analgesia with morphine for 48 h post-operatively. ⋯ The time to be able to perform a straight leg raise and to reach a 90 degrees knee flexion was significantly shorter in the trial group compared with the controls. This study demonstrated that an intra-operative intra-articular magnesium sulphate and ropivacaine injection reduced the use of post-operative morphine.
-
Randomized Controlled Trial Comparative Study
Comparison of stress hormone response, interleukin-6 and anaesthetic characteristics of two anaesthetic techniques: volatile induction and maintenance of anaesthesia using sevoflurane versus total intravenous anaesthesia using propofol and remifentanil.
This prospective randomized study compared the effects of two types of anaesthesia on peri-operative anaesthetic profiles from induction to recovery and on immunological and neurohormonal responses to anaesthesia and surgical stress. Forty patients were assigned to undergo either volatile induction and maintenance of anaesthesia (VIMA) with sevoflurane or total intravenous anaesthesia (TIVA) with propofol and remifentanil. ⋯ Adrenaline, noradrenaline, cortisol and glucose levels were significantly lower with TIVA than VIMA, but there was no difference in IL-6 levels between the two groups. TIVA with propofol and remifentanil may be preferable to VIMA with sevoflurane alone because it leads to smoother, more rapid induction, more rapid awakening and lower stress responses to surgical stimuli.
-
Randomized Controlled Trial
Phenylephrine attenuates intra-operative hypothermia during spinal anaesthesia.
Inadvertent hypothermia is common during spinal anaesthesia. This study was based on the hypothesis that phenylephrine might attenuate core hypothermia by inhibiting core-to-peripheral redistribution of body heat during spinal anaesthesia. In this prospective randomized study, 20 patients who underwent elective orthopaedic surgery under spinal anaesthesia were randomly assigned to receive either normal saline (control group) or continuously-infused phenylephrine 0.5 microg/kg per min (phenylephrine group). ⋯ Mean +/- SE core temperature at the end of surgery was significantly higher in the phenylephrine-treated group compared with the control group (35.9 +/- 0.1 degrees C versus 35.0 +/- 0.1 degrees C, respectively), although there was no significant difference in baseline core temperature (both groups 36.3 +/- 0.1 degrees C). Mean HR and MAP were not significantly different between the two groups. In conclusion, continuously-infused phenylephrine attenuated core hypothermia during spinal anaesthesia without any haemodynamic complications.
-
Comparative Study Clinical Trial
Comparison of anti-Xa activity after a single intravenous bolus of low-dose enoxaparin in patients with and without end-stage renal disease.
This study was designed to evaluate anti-Xa activity hourly during the first 3 h after a single intravenous bolus of 0.5 mg/kg enoxaparin in 30 patients with end-stage renal disease (ESRD) who underwent haemodialysis, and in 30 patients with normal or mildly reduced renal function who underwent coronary angiography for chest pain (non-ESRD group). Mean +/- SD haemodialysis time was 3.9 +/- 0.3 h in the ESRD group. Of 24 patients diagnosed with coronary artery disease in the non-ESRD group, 20 underwent percutaneous coronary intervention (PCI). ⋯ The percentages of patients with peak anti-Xa activity in the target range (0.5 - 1.5 IU/ml) were similar in the two groups (non-ESRD 80%, ESRD 93%). Adequate anti-Xa activity (> 0.5 IU/ml) lasted about 2 h in both groups. It is concluded that a single intravenous low-dose enoxaparin (0.5 mg/kg) bolus provides anti-Xa activity adequate for elective PCI within 2 h irrespective of whether or not the patient had ESRD.
-
This prospective study investigated the levels of procalcitonin (PCT) and C-reactive protein (CRP) in patients with various types and severity of multiple trauma, and their relationship to trauma-related complications. Adult multiple-trauma patients (n = 113) admitted to the intensive care unit (ICU) in the first 24 h after trauma were included. The Injury Severity Scores (ISS), and PCT and CRP levels were measured in the first 24 h (day 1), on day 7 and on the final day of their ICU stay. ⋯ Mean PCT and CRP levels were both significantly higher on day 7 compared with day 1 and the final assessment day in patients with an ISS > 20. Levels of PCT were significantly higher in cases with sepsis, severe sepsis or septic shock compared with cases who developed systemic inflammatory response syndrome (SIRS), however levels of CRP were significantly higher only in cases with severe sepsis or septic shock, but not in cases with sepsis alone. These data support the view that PCT levels may be a better indicator than CRP levels in the early diagnosis of septic complications in patients with multiple trauma.