Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · May 2004
Review Comparative StudyA systematic review of COX-2 inhibitors compared with traditional NSAIDs, or different COX-2 inhibitors for post-operative pain.
We have reviewed the analgesic efficacy of cyclooxygenase-2 (COX-2) inhibitors compared with traditional non-steroidal anti-inflammatory drugs (NSAIDs), different COX-2 inhibitors, and placebo in post-operative pain. ⋯ Rofecoxib 50 mg and parecoxib 40 mg have an equipotent analgesic efficacy relative to traditional NSAIDs in post-operative pain after minor and major surgical procedures, and after dental surgery these COX-2 inhibitors have a longer duration of action. Besides, rofecoxib 50 mg provides superior analgesic effect compared with celecoxib 200 mg.
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Acta Anaesthesiol Scand · May 2004
Clinical Trial Controlled Clinical TrialThe analgesic effect of morphine on postoperative pain in diabetic patients.
Many clinical and experimental studies have suggested that diabetes or hyperglycemia alter opioid responsiveness. However, little information is available on the effects of diabetes mellitus on opioid requirements in the postoperative period. ⋯ The findings of the study appear to support experimental and clinical impressions that the analgesic effect of morphine is attenuated in hyperglycemic conditions. Therefore, larger doses of morphine may be administered to diabetic patients for effective postoperative analgesia.
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Acta Anaesthesiol Scand · May 2004
Comparative Study Clinical TrialComparison of the concentration-dependent effect of sevoflurane on the spinal H-reflex and the EEG in humans.
It has been shown that spinal reflexes such as the H-reflex predict motor responses to painful stimuli better than cortical parameters derived from the EEG. The precise concentration-dependence of H-reflex suppression by anaesthetics, however, is not known. Here we investigated this concentration-response relationship and the equilibration between the alveolar and the effect compartment for sevoflurane. ⋯ The differences in EC(50) and slope of the concentration-response relationships for H-reflex suppression and the EEG parameters point to different underlying mechanisms. In addition, the differences in time constant for equilibration between alveolar and effect compartment confirm the notion that immobility is caused at a different anatomic site than suppression of the EEG.
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Acta Anaesthesiol Scand · May 2004
Comparative Study Clinical TrialComparison of the neuromuscular blocking effect of cisatracurium and atracurium on the larynx and the adductor pollicis.
Cisatracurium unlike atracurium is devoid of histamine-induced cardiovascular effects and this alone would be the greatest advantage in replacing atracurium for the facilitation of tracheal intubation. On the other hand, 2 ED(95) doses of cisatracurium (100 micro g/kg) do not yield satisfactory intubating conditions such as those seen with equipotent doses of atracurium and therefore the recommended intubating dose of cisatracurium is 3 ED(95). To understand this discrepancy better, we evaluated the potency and onset of atracurium and cisatracurium directly at the larynx adductors in humans. ⋯ The slow onset time at the laryngeal muscles after cisatracurium can be explained by the higher potency as compared with atracurium.
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Acta Anaesthesiol Scand · May 2004
The use of undiluted amiodarone in the management of out-of-hospital cardiac arrest.
The Resuscitation 2000 Guidelines recommends amiodarone as the antiarrhythmic drug of choice in treatment of resistant ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT). Amiodarone has been associated with side-effects and difficulty of administration, due to recommended dilution, rendering it suboptimal for out-of-hospital cardiac arrest (CA) management. In the present study we report experiences and side-effects of the use of undiluted amiodarone in CA management in Helsinki Emergency Medical Service (EMS) during a 2-year period. ⋯ The present study suggests that amiodarone can be administered undiluted without unmanageable haemodynamical side-effects in the treatment of out-of-hospital cardiac arrest. This is likely to save time and simplifies the treatment protocol in the prehospital setting.