Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Randomized Controlled Trial Comparative Study Clinical Trial
Oral premedication for paediatric ambulatory anaesthesia: a comparison of midazolam and ketamine.
To compare the clinical characteristics of two oral premedicants, midazolam and ketamine, 40 healthy children, one to six years of age, who were scheduled for ambulatory dental surgery, were assigned to receive either oral midazolam 0.5 mg.kg-1 or oral ketamine 5.0 mg.kg-1 in a double-blind, randomized study. Sedation and anxiolysis scores before induction, cooperation at induction of anaesthesia and recovery times and complications were assessed. We found that both drugs effectively sedated the children within 20 min of administration. ⋯ No important side effects were attributable to either premedication. The time until the children were fit for discharge from the hospital after midazolam was approximately 20 min less than after ketamine. In conclusion, midazolam and ketamine offer similar clinical characteristics when used as oral premedications for children undergoing ambulatory surgery, although the time to discharge from hospital may be more rapid after midazolam than after ketamine.
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The purpose of the study was to determine the effect of nondepolarizing muscle relaxants and waiting time on muscle fasciculations after succinylcholine in anaesthetized patients. Adult men and women, 60-80 kg, received pretreatment doses of atracurium 5 mg (n = 160), pancuronium 1 mg (n = 123), d-tubocurarine 3 mg (n = 97), or vecuronium 1 mg (n = 62). Waiting times between pretreatment and succinylcholine, 100 mg, ranged between 0.6 and 5 min. ⋯ Following wait times of three, four and five minutes, the probability of not fasciculating was greatest with d-tubocurarine (90, 97 and 99%, respectively) and atracurium (89, 93 and 96%). Corresponding values for pancuronium were 70, 82 and 88% and for vecuronium were 74, 82 and 86%. Waiting times to prevent fasciculations in 80% and 90% of patients were shorter with d-tubocurarine (2.46 and 3.02 min, respectively) or atracurium (2.16 and 3.24 min) than pancuronium (3.77 and 5.35 min) or vecuronium (3.73 and 6.36 min).(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of lumbar epidural and intravenous fentanyl infusions for post-thoracotomy analgesia.
This double-blind randomised study compared the analgesic efficacy, respiratory effects, side effects, and pharmacokinetic disposition of 24 hr lumbar epidural and intravenous infusions of the same dosage regimen of fentanyl (1.5 micrograms.kg-1 bolus then 1 microgram.kg-1.hr-1 infusion) in 50 patients after thoracotomy. Patients received either epidural fentanyl and intravenous normal saline, or epidural normal saline and intravenous fentanyl, for postoperative analgesia, after a standard low-dose alfentanil and isoflurane general anaesthetic. Visual analogue pain scores were lower in the epidural group (P < 0.05) only at two hours postoperatively, and there was no difference in the amount of supplementary morphine self-administered by patient-controlled analgesic pump. ⋯ Thereafter there was no difference in the plasma concentration profiles between the two groups. Seven patients in the epidural group and ten patients in the intravenous group received naloxone for PaCO2 > 50 mmHg, and one patient in the intravenous group had the infusions stopped because of PaCO2 elevation and somnolence. In patients who did not receive naloxone, the epidural route produced better analgesia throughout the study period (P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)