Anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Haemodynamic and neurohumoral effects of xenon anaesthesia. A comparison with nitrous oxide.
Thirty-two patients were randomly allocated to be anaesthetised either with nitrous oxide or xenon. Those who received nitrous oxide required significantly more fentanyl peroperatively. Arterial blood pressure and heart rate were adequately controlled during surgery in both groups. ⋯ Postoperative plasma concentrations of noradrenaline, adrenaline, cortisol and prolactin (in both groups) and dopamine (in the nitrous oxide group) were elevated, and slowly returned to control. No differences were seen between the two gases in effects on plasma sodium and potassium. Xenon, because of its favourable haemodynamic, neurohumoral and antinociceptive properties, deserves a more prominent place in anaesthetic practice than it has so far occupied.
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Randomized Controlled Trial Clinical Trial
Epidural fentanyl and 0.5% bupivacaine for elective caesarean section.
Either 100 micrograms fentanyl or 2 ml saline was added to 0.5% bupivacaine administered epidurally for elective Caesarean section in 30 patients, in a double-blind randomised study. Bupivacaine 0.5% was administered until a complete sensory block was established extending to the 4th thoracic dermatome. ⋯ Postoperative analgesia was of longer duration in those who received epidural fentanyl (p less than 0.01). There were no deleterious effects on neonatal or maternal outcome.
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Randomized Controlled Trial Clinical Trial
Latency of brachial plexus block. The effect on onset time of warming local anaesthetic solutions.
A double-blind study was set up to investigate the effect of warming local anaesthetic solutions on the latency of onset of subclavian perivascular brachial plexus blocks. Twenty-four adult patients were randomly allocated into two equal groups. ⋯ The speed of onset of sensory blockade was significantly increased when the temperature of the local anaesthetic solution was increased to 37 degrees C. There were no adverse side effects in either group.
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Randomized Controlled Trial Clinical Trial
Propofol sedation after open heart surgery. A clinical and pharmacokinetic study.
One hundred adult patients who required mechanical ventilation after open heart surgery for coronary revascularisation were studied. All received a standard premedication and a high dose opioid anaesthetic. On arrival in the intensive care unit they were allocated randomly to receive either propofol or midazolam to maintain sedation within a predetermined range. ⋯ There were significantly higher morphine requirements during sedation, and higher arterial carbon dioxide tensions 30 minutes after extubation of the trachea, in patients who received midazolam. Pharmacokinetic analysis in 20 patients showed that the elimination half-life of propofol was prolonged (470 minutes) and clearance was reduced (1.14 litres/minute) compared with subjects who had not undergone cardiopulmonary bypass. The rapid clinical recovery was reflected in a rapid redistribution half-life (13.4 minutes), but this was also longer than the redistribution time of 2-4 minutes in other patients.
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Randomized Controlled Trial Clinical Trial
Postoperative nefopam and diclofenac. Evaluation of their morphine-sparing effect after upper abdominal surgery.
The aim of the study was to assess the relative morphine-sparing effects of nefopam and diclofenac when used singly or in combination after upper abdominal surgery. Eighty-four patients of ASA grade 1 or 2 were allocated randomly to one of three groups. Group A received nefopam 20 mg by intramuscular injection 6 hourly after surgery for the 24-hour study period. ⋯ Morphine requirements in the diclofenac group were significantly lower than in either of the other groups (p less than 0.01). Patients who received the combination of nefopam and diclofenac required significantly less morphine than those who received nefopam alone (p less than 0.01). Pain scores assessed 6 hours after surgery were significantly lower in the diclofenac and combination groups compared with the nefopam group (p less than 0.01).