Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Oct 1992
Randomized Controlled Trial Clinical TrialIncreased volume of gastric contents in diabetic patients undergoing renal transplantation: lack of effect with cisapride.
Gastroparesis is a frequently unrecognized complication of insulin-dependent diabetes mellitus, which subjects these patients to the risk of aspiration at induction of anaesthesia. The effect of oral cisapride on volume and pH of gastric contents was studied in 24 diabetic and 24 non-diabetic uraemic patients undergoing renal transplantation. All patients were allocated randomly in a double-blind fashion to receive either 10 mg of cisapride or placebo orally approximately 100 min before anaesthesia and three times daily for the first 2 postoperative days. ⋯ Cisapride lacked effect on gastric contents and postoperative gastrointestinal motility. Diabetic uraemic patients had larger gastric volumes than their non-diabetic controls at induction of anaesthesia. Cisapride had no effect on gastric emptying preoperatively nor on postoperative bowel function.
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Acta Anaesthesiol Scand · Oct 1992
Randomized Controlled Trial Clinical Trial Controlled Clinical TrialTen ml bupivacaine 0.125% with 12.5 micrograms epinephrine is a reliable epidural test dose to detect inadvertent intravascular injection in obstetric patients. A double-blind study.
A double-blind study was designed in order to determine the specificity and sensitivity of an epidural test dose to detect inadvertent intravenous injection in obstetric patients undergoing epidural analgesia. Forty unselected obstetric patients were given an intravenous injection of 10 ml bupivacaine 0.125% with 12.5 micrograms epinephrine (test dose) or 10 ml normal physiologic saline. The maternal heart rate was monitored by the direct ECG mode of a fetal monitor and registered simultaneously with the tocogram. ⋯ For the primary investigator, the specificity of the test dose was 100% and the sensitivity 97.5%. The judgments of the 8 other anesthesiologists resulted in an excellent specificity (99.1%) and a good sensitivity (91.9% with information on time of injection and subjective signs and symptoms). The better performance of the primary investigator is probably due to the availability of blood pressure data.
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Acta Anaesthesiol Scand · Oct 1992
Randomized Controlled Trial Clinical TrialThiopentone or propofol for induction of isoflurane-based anaesthesia for ambulatory surgery?
This study compares psychomotor recovery following induction of anaesthesia with either thiopentone or propofol in 30 healthy, unpremedicated patients undergoing outpatient arthroscopic procedures of the knee. A battery of tests including simple reaction time (SRT), choice reaction time (CRT), perceptive accuracy test (PAT) and digit symbol substitution test (DSST) were done before anaesthesia. The patients were randomly divided into two groups: Group 1 was induced with thiopentone 5-6 mg/kg while Group 2 was induced with propofol 2-3 mg/kg. ⋯ The SRT, CRT and DSST proved to be relatively insensitive in the detection of residual effects of anaesthesia and had a significant learning effect. This study suggests that induction of anaesthesia with propofol followed by maintenance with isoflurane in oxygen and air during spontaneous ventilation is associated with rapid psychomotor recovery and is a suitable method for ambulatory surgery. The PAT is sensitive and not associated with some of the problems found with other commonly used tests.
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Acta Anaesthesiol Scand · Oct 1992
Randomized Controlled Trial Comparative Study Clinical TrialComparison of ketorolac and morphine for postoperative pain after major surgery.
This study was designed to determine the relative analgesic efficacy and safety of single intramuscular injections of ketorolac (10 mg or 30 mg) and morphine (10 mg) in patients of either sex with moderate to severe pain after major surgery. In a single-dose, randomised, double-blind study of parallel design, pain was assessed immediately before injection of test medication and at regular intervals for 8 h thereafter. One hundred and seventeen patients (109 undergoing cardiac surgery; 8 lung surgery) were randomized to one of the three treatment groups. ⋯ The results of this study show that ketorolac is an effective and safe (with regard to arterial pressure, blood gases and lung function) analgesic for relief of postoperative pain after major surgery in stable patients. No clinically significant adverse effects occurred during the study. One cannot exclude an influence on patients with organ system dysfunction or on parameters not measured in this study.
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Acta Anaesthesiol Scand · Oct 1992
Randomized Controlled Trial Comparative Study Clinical TrialEffects of epinephrine and clonidine on plasma concentrations of spinal bupivacaine.
ASA II-III patients, scheduled for peripheral vascular surgery, were included in a study designed to assess the effect of spinal epinephrine and clonidine on plasma concentrations of spinally administered 0.5% glucose-free bupivacaine. Patients were allocated randomly to three groups to receive via a spinal catheter 22.5 mg (4.5 ml) of bupivacaine alone (Group B, 9 patients) or combined with 0.3 mg epinephrine (Group BE, 10 patients) or 0.15 mg clonidine (Group BC, 10 patients). ⋯ A trend to prolongation of local anaesthetic blockade was documented in patients receiving bupivacaine plus epinephrine or clonidine. (Time to regression of sensory blockade to L2: 170 +/- 75 min in Group B, 230 +/- 50 min in Group BE, 232 +/- 64 min in Group BC.) The maximum peak concentration (Cmax), the time to reach Cmax (Tmax) and the time-concentration curve from 0-180 min (AUC) were not different for the three groups (Cmax 228 +/- 112 ng.ml-1 in Group B, 215 +/- 103 ng.ml-1 in Group BE, 234 +/- 159 ng.ml-1 in Group BC; Tmax 41 +/- 34 min in Group B, 59 +/- 31 min in Group BE, 68 +/- 32 min in Group BC; AUC 31.0 +/- 1.7 mg.ml-1.min-1 in Group B, 27.3 +/- 1.1 mg.ml-1.min-1 in Group BE, 27.0 +/- 1.1 mg.ml-1.min-1 in Group BC). The results of this study suggest that epinephrine and clonidine do not decrease blood resorption of spinal bupivacaine.