Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Randomized Controlled Trial Clinical Trial
Duration of decubitus position after epidural blood patch.
Thirty patients presenting with post-dural puncture headache (PDPH) were prospectively studied to determine the influence of the duration of the decubitus position after epidural blood patch on the efficacy of treatment. All patients received 12 ml of autologous blood. They were randomly distributed into three groups of ten patients. ⋯ The severity of PDPH in the three groups was reduced at the time of initially adopting a standing position and after 24 hr, in comparison with preblood patch VAS (P < 0.001). Patients in Group 3 presented less severe PDPH than patients in Group 1 at the time of initially standing up and 24 hr later (P < 0.05). We conclude that epidural blood patch was effective in treating PDPH but that the maintenance of a decubitus position for at least one hour and preferably for two hours after the blood patch was more effective than maintenance for 30 min.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
A multicentre randomized study of single-unit dose package of EMLA patch vs EMLA 5% cream for venepuncture in children.
Eutectic mixture of local anaesthetics (EMLA) cream with Tegaderm was compared with pre-packaged EMLA patch with regard to analgesic effect, adhesiveness and local reactions during venepuncture in 178 children from three to ten years. One EMLA patch, or half the contents of a 5 g tube of EMLA cream plus Tegaderm was applied to the dorsum of one hand or antecubital fossa for a minimum of 60 min before venepuncture. The subject and observer assessed the degree of pain on a three-point verbal rating scale. ⋯ There was no difference between the two treatment groups in terms of overall local reactions. The patch was less adhesive (P < 0.001), but this had no apparent influence on its effectiveness. In conclusion, EMLA patch is equivalent to 5% EMLA cream (2.5 g) in cutaneous pain relief when used for venepuncture in children.
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Randomized Controlled Trial Comparative Study Clinical Trial
Propofol anaesthesia in paediatric ambulatory patients: a comparison with thiopentone and halothane.
The purpose of this study was to evaluate the haemodynamic changes during induction, as well as the speed and quality of recovery when propofol (vs thiopentone and/or halothane) was used for induction and maintenance of anaesthesia in paediatric outpatients. One hundred unmedicated children, 3-12-yr-old, scheduled for ambulatory surgery were studied. The most common surgical procedures performed were eye muscle surgery (42%), plastic surgery (21%), dental restoration (15%), and urological procedures (15%). ⋯ The mean propofol dose required to prevent movement was 267 +/- 83 micrograms.kg-1.min-1. The overall pattern of haemodynamic changes, as well as awakening (extubation) times were not different among the four groups. Children who received propofol recovered faster (22 vs 29-36 min) (P < 0.05), were discharged home sooner (101 vs 127-144 min) (P < 0.05), and had less postoperative vomiting (4 vs 24-48%) (P < 0.05) than all others.(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Clinical Trial
Recovery of neuromuscular function after atracurium and pancuronium maintenance of pancuronium block.
The study was undertaken to determine whether a neuromuscular blockade induced with pancuronium but maintained with atracurium was associated with a shorter time to complete recovery after administration of neostigmine than if the blockade was maintained with pancuronium alone. Anaesthesia consisted of thiopentone, N2O/O2/enflurane and fentanyl, and the neuromuscular blockade, induced by pancuronium 0.1 mg.kg-1 was monitored by the force of contraction of adductor pollicis during major abdominal surgery lasting 2-5 hr. In 24 patients--Group 1--atracurium 0.07 mg.kg-1 was repeated when the first twitch of the train-of-four (TOF) returned to 25% of control (T1/TC 25). ⋯ The time from injection of the reversal drugs to a TOF ratio of 70% was similar in both groups (Group 1, 11.6 +/- 7.6 min; Group 2, 10.1 +/- 6 min; P = NS), but the recovery index was smaller in Group 2 (Group 1, 4 +/- 2.6 min; Group 2, 2.61 +/- 1.2 min; P < 0.05). Furthermore, there was no difference between groups in the duration of action of each redose. The study showed that when compared with pancuronium, equipotent doses of atracurium were not associated with (a) a shorter time to complete recovery from a neuromuscular blockade induced with pancuronium or (b) a shorter duration of action.