Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Randomized Controlled Trial Comparative Study Clinical Trial
Reversal of doxacurium and pancuronium neuromuscular blockade with neostigmine in children.
Recovery after doxacurium and pancuronium neuromuscular blockade and their acceleration by neostigmine have not been compared in children. Therefore, 60 paediatric surgical patients aged 2-10 yr (ASA 1-2) were studied. They were randomized to receive doxacurium 30 micrograms.kg-1 or pancuronium 70 micrograms.kg-1 iv during propofol, fentanyl, isoflurane and nitrous oxide anaesthesia. ⋯ Neostigmine-assisted recovery was not different in the two groups, with ED70 and ED90 doses for T1 of 14.3 +/- 1.8 and 25.7 +/- 2.7 micrograms.kg-1 for doxacurium and 12.5 +/- 1.7 and 25.3 +/- 2.3 micrograms.kg-1 for pancuronium. Time to recovery of TOF ratio to 70% after neostigmine 40 micrograms.kg-1 was 2.3 +/- 1.0 and 4.2 +/- 1.7 min (P = NS) following pancuronium and doxacurium, respectively. Adjusted recovery due to neostigmine alone (spontaneous recovery subtracted from the total) required two to three times higher doses of neostigmine.(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Comparative Study Clinical Trial
Postoperative sore throat in children and the laryngeal mask airway.
Postoperative sore throat is a minor complaint after general anaesthesia of multifactorial aetiology. The purpose of this study was to compare the effect of the laryngeal mask airway (LMA) and endotracheal tube (ETT) on postoperative sore throat in children. We hypothesized that the incidence of sore throat would be less after the use of the LMA. ⋯ All of the reported sore throats were rated as mild. In conclusion, postoperative sore throats after minor paediatric surgery is uncommon. If it does occur, it is mild and the incidence is unaffected by the choice of an LMA or ETT.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of a rigid laryngoscope with the ultrathin fibreoptic laryngoscope for tracheal intubation in infants.
The flexible ultrathin fibreoptic laryngoscope allows placement of endotracheal tubes as small as 2.5 mm internal diameter. The purpose of this study was to document the safety and efficacy of intubation using an ultrathin fibreoptic laryngoscope. Proved safety and efficacy would justify the routine use of fibreoptic laryngoscopy in normal infants to maintain skills needed for management of the difficult infant airway. ⋯ After intubation, blood pressure and heart rate increased equally in both groups, returning to normal within one to two minutes. There was no difference in the airway trauma between groups. We conclude that the ultrathin fibreoptic laryngoscope is a safe and effective method for tracheal intubation in infants and may be used routinely in order to maintain fibreoptic airway skills.
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Randomized Controlled Trial Comparative Study Clinical Trial
Prophylactic oral ephedrine reduces the incidence of hypotension after subarachnoid block.
The purpose of this study was to demonstrate the efficacy of oral ephedrine in preventing hypotension following subarachnoid block. Two hundred women, ASA physical status I or II, undergoing lower abdominal surgery were randomly divided into two groups (n = 100 each). All patients were given routine oral premedication consisting of diazepam 10 mg and ranitidine 150 mg at bed time and at 90 min before surgery. ⋯ Despite a similar level of block (T3-T4) and i.v. fluids, the total dose of ephedrine supplement in Group I was 4.3 +/- 4.8 mg compared with 11.6 +/- 9.4 mg in Group II (P < 0.01). Also, 55 patients in Group I required intraoperative inotrope supplement compared with 83 in Group II (P < 0.01). We conclude that oral ephedrine premedication is a simple and effective way of reducing the incidence of hypotension in patients undergoing lower abdominal surgery under subarachnoid block.
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Epsilon-aminocaproic acid and tranexamic acid, two synthetic antifibrinolytics, and aprotinin, an antifibrinolytic derived from bovine lung, are used to reduce excessive bleeding and transfusion of homologous blood products (HBP) after cardiac surgery. This review analyzes the studies on the utilization of antifibrinolytics in adult cardiac surgery according to the epidemiological concepts of efficacy, effectiveness and efficiency. A majority of published studies confirm the efficacy of antifibrinolytics administered prophylactically to reduce postoperative bleeding and transfusion of HBP. ⋯ At this time, insufficient data have been published to perform a cost vs benefit analysis of the use of antifibrinolytics. This complex analysis takes into account not only direct costs (cost of the drug and of blood products), but also the ensuing effects of treatment such as: length of stay in the operating room, in the intensive care unit and in the hospital; need for surgical re-exploration; treatment of transfusion or drug-related complications, etc. In particular, the risk of thrombotic complications associated with antifibrinolytics is the subject of an ongoing, unresolved controversy.(ABSTRACT TRUNCATED AT 250 WORDS)