Anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Antagonism of atracurium with neostigmine. Effect of dose on speed of recovery.
In 36 patients in whom anaesthesia was maintained with nitrous oxide and 0.5% isoflurane an atracurium-induced neuromuscular block was either allowed to recover spontaneously or antagonised with one of four doses of neostigmine (15 micrograms/kg, 35 micrograms/kg, 55 micrograms/kg or 75 micrograms/kg). The recovery times to a train-of-four ratio of 0.5, 0.75 and 0.9 were recorded. In patients given neostigmine, antagonism was at an average T1 of between 8.8% and 14.9%. ⋯ Recovery after neostigmine 15 micrograms/kg was significantly slower than after the higher doses. One patient given neostigmine 75 micrograms/kg showed an unusual bimodal pattern of recovery. There appears to be no benefit in giving a larger dose than 35 micrograms/kg of neostogmine as a single bolus.
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Randomized Controlled Trial Comparative Study Clinical Trial
Patient-controlled on-demand epidural fentanyl. A comparison of patient-controlled on-demand fentanyl delivered epidurally or intravenously.
A prospective, open, clinical trial is described in which 20 patients having upper abdominal surgery were randomly allocated to receive fentanyl for postoperative analgesia by patient-controlled demand analgesic computer by either the epidural or intravenous route. Hourly pain, sedation and nausea scores were very similar in the two groups during the first 24 hours after surgery. What few differences there were favoured the epidural group. There was a highly significant difference in fentanyl consumption between the two groups, with the intravenous group demanding consistently more than twice as much as the epidural group.
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Comparative Study
A comparison of APACHE II and a clinical sickness score. A study of 97 consecutive admissions to a district general hospital intensive care unit.
The aim of this study was to compare the predictive power of a simple illness severity score (Clinical Sickness Score) to that of APACHE II in a District General Hospital intensive therapy unit. A prospective comparison was carried out on 97 consecutive adult patients whose severity of illness was scored one hour after admission using both the Clinical Sickness Score and APACHE II. Intensive Therapy Unit and hospital outcomes were recorded for each patient. ⋯ Correlation for hospital nonsurvivors was not significant (r = 0.1629, r2 = 0.027, p = 0.3134). The positive predictive values of APACHE II were between 5% and 10% more sensitive than the Clinical Sickness Score for hospital outcome. Admission Clinical Sickness Score and APACHE II scores had similar predictive power in this study.
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One thousand patients who were anaesthetised between February and April 1990 at University Hospital, Nottingham were interviewed between 20 and 36 hours after their operation. Patients under 16 years of age, those who had undergone obstetric or intracranial surgery, those who were unable to communicate and patients who were discharged from hospital before the postoperative visit were not interviewed. A standard set of questions was used to determine the incidences of recall of events and dreams during the operation. These incidences were 0.2% and 0.9% respectively, considerably lower than reported in previous comparable studies.