Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Randomized Controlled Trial Comparative Study Clinical Trial
Optimal anti-emetic dose of granisetron for preventing postoperative nausea and vomiting.
In order to determine the optimal effective dose of granisetron for preventing postoperative nausea and vomiting, the drug was administered in doses of either 20, 40 or 60 micrograms.kg-1. The efficacy of granisetron was evaluated in a randomized, double-blind comparison with placebo in 100 patients undergoing general anaesthesia for major gynaecological surgery. The patients received a single dose of either granisetron or placebo (saline) iv immediately after recovery from anaesthesia. ⋯ The mean scores were 0.7, 0.6, 0.2 and 0.2 after administration of placebo, granisetron 20, 40 and 60 micrograms.kg-1, respectively. Granisetron 40 micrograms.kg-1 was as effective as 60 micrograms.kg-1 and both resulted in reduction of the scores compared with placebo and granisetron 20 micrograms.kg-1 (P < 0.05). In conclusion, granisetron 40 micrograms.kg-1 is considered to be the appropriate dosage for preventing postoperative emesis after anaesthesia.
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Randomized Controlled Trial Clinical Trial
Optimizing sedation following major vascular surgery: a double-blind study of midazolam administered by continuous infusion.
A randomized, double-blind study was undertaken to determine the dose requirements, recovery characteristics, and pharmacokinetic variables of midazolam given by continuous infusion for sedation in patients following abdominal aortic surgery. Thirty subjects, 50-75 yr, scheduled to undergo aortic reconstructive surgery, entered the study. Following a nitrous oxide-isoflurane-opioid anaesthetic technique, patients were randomly allocated to receive one of three loading doses (0.03, 0.06 or 0.1 mg.kg-1) and initial infusion rates (0.5, 1.0 or 1.5 micrograms.kg-1.min-1) of midazolam, corresponding to groups low (L), moderate (M) and high (H). ⋯ Times to awakening were longer in Group H: 3.1 +/- 3.4 hr, than in Group L: 1.1 +/- 0.8 h, P < 0.05. Pharmacokinetic variables were found to be dose-independent over the range of infusion rates. Mean values were t1/2 beta = 4.4 +/- 1.5 hr, CL = 5.94 +/- 1.69 mL.min-1.kg-1, Vd = 3.13 +/- 1.07 L.kg-1.(ABSTRACT TRUNCATED AT 400 WORDS)
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We present a case of 100% pneumothorax in a 41-yr-old man with a history of gastritis and gastroesophageal reflux scheduled for Nissen fundoplication. The patient was anaesthetized, and insufflation of the abdominal cavity with carbon dioxide was performed uneventfully. There was an increase in the peak inspiratory pressure and wheezing was noted with a decrease in the arterial oxygen saturation to 91%. ⋯ A chest roentgenogram showed a 100% left pneumothorax. A left chest tube was placed with immediate improvement of the arterial oxygen saturation to 100%. We recommend monitoring of arterial oxygen saturation, peak inspiratory pressures, and excursion of the chest for early diagnosis and prompt treatment of pneumothorax during laparoscopic procedures.
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Most patients undergoing general anaesthesia are apnoeic during laryngoscopy and tracheal intubation. This study determined the time until the onset of desaturation following pre-oxygenation in apnoeic infants, children, and adolescents. Fifty ASA physical status I patients, 2 days to 18 yr of age, were studied. ⋯ Children became desaturated faster than adolescents (160.4 +/- 30.7 vs 382.4 +/- 79.9 sec, P < 0.0001). The time required to reach 90% saturation correlated well with age by linear regression analysis (r2 = 0.88, P < 0.0001). We conclude that the time to onset of desaturation following pre-oxygenation with mask ventilation increases with age in healthy apnoeic children.(ABSTRACT TRUNCATED AT 250 WORDS)