Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Randomized Controlled Trial Comparative Study Clinical Trial
Patient-controlled analgesia following caesarean section under general anaesthesia: a comparison of fentanyl with morphine.
This prospective, randomised, double-blind study compared PCA fentanyl with PCA morphine for post-Caesarean section analgesia. Following a standardised general anaesthetic, 37 women were allocated to receive either fentanyl (n = 18) or morphine (n = 19). The PCA was commenced after the women had been made comfortable in the postanaesthetic recovery room with the appropriate opioid solution (mean dose required = fentanyl 375 micrograms or morphine 16 mg). ⋯ Both analgesic solutions provided effective analgesia for a mean of 37 hr with high levels of patient satisfaction, and there were no differences in VAS scores for pain and patient satisfaction, or for side effects (nausea, itch, and sleepiness) between fentanyl or morphine. However, more patients in the fentanyl group required supplementary boluses or alterations to the PCA settings (13/18 vs 4/19: P = 0.005), and one patient was removed from the study due to inadequate analgesia. We conclude that fentanyl is not recommended for routine PCA use following Caesarean section.
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Randomized Controlled Trial Comparative Study Clinical Trial
Circulatory responses to laryngeal mask airway insertion or tracheal intubation in normotensive and hypertensive patients.
The effects of laryngeal mask airway (LMA) insertion and tracheal intubation on circulatory responses were studied in normotensive (n = 24) and hypertensive (n = 22) patients. In a randomized, double-blind manner, LMA insertion or tracheal intubation was performed after induction of anaesthesia with thiopentone and muscle relaxation with succinylcholine. In both normotensive and hypertensive patients, heart rate (HR), mean arterial pressure (MAP) and rate-pressure product increased after tracheal intubation or LMA insertion compared with baseline (P < 0.05). ⋯ The increase in noradrenaline concentration after tracheal intubation was greater than that after LMA insertion (P < 0.05). No patient revealed ECG evidence of myocardial ischaemia. We conclude that insertion of LMA is associated with less circulatory responses than tracheal intubation in both normotensive and hypertensive patients.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of tactile and mechanomyographical assessment of response to double burst and train-of-four stimulation during moderate and profound neuromuscular blockade.
It is common clinical practice to estimate the degree of neuromuscular blockade by tactile evaluation of twitch responses. The aim of the present study was to evaluate the use of tactile responses of adductor pollicis to double-burst stimulation (DBS) and train-of-four (TOF) peripheral nerve stimulation for monitoring moderate and profound levels of neuromuscular blockade. The study comprised 44 women scheduled for gynaecological laparotomy and anaesthetised with midazolam, fentanyl, thiopentone, halothane, nitrous oxide and atracurium. ⋯ One or two responses to DBS or TOF were often felt before any responses had been detected mechanomyographically in the contralateral arm. When three or four responses to TOF were felt, responses were always detected mechanomyographically. It is concluded that tactile evaluation of responses ot DBS stimulation can estimate deeper levels of blockade than tactile evaluation of responses to TOF.
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Comparative Study
Amrinone improves contractility of fatigued diaphragm in dogs.
The effects of amrinone, a bipyridine derivative, on diaphragmatic contractility and fatigue were examined in 36 anaesthetized, mechanically ventilated dogs divided into four groups. In Group Ia (n = 8), dogs without diaphragmatic fatigue were given a bolus injection (0.75 mg.kg-1) followed by continuous infusion (10 micrograms.kg-1.min-1) of amrinone iv. In Group Ib (n = 8), animals without fatigue received infusion only of maintenance fluid. ⋯ In Group IIb, the speed of recovery from fatigue was relatively slower at low-frequency stimulation. The integrated diaphragmatic electric activity (Edi) did not change throughout the experiment. These results indicate that amrinone improves contractility in the fatigued diaphragm.
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We describe three patients with long-standing ankyolsing spondylitis (AS) who underwent lower limb joint surgery under spinal anaesthesia. At preoperative assessment, it was considered that intubation of the trachea was likely to be difficult or impossible and previous general anaesthesia was associated with increased morbidity. ⋯ This resulted in adequate sensory blockade for the surgical procedure. None of the patients required airway interventions but equipment and aids to secure airway were available.