Anaesthesia
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Randomized Controlled Trial Clinical Trial
The influence of nitrous oxide on propofol dosage and recovery after total intravenous anaesthesia for day-case surgery.
We studied the influence of nitrous oxide on the maintenance dose of propofol and recovery characteristics in 42 patients, aged 18-62 years, ASA 1 or 2, scheduled for day case inguinal herniotomy. Using a double-blind, randomised design, patients received anaesthesia with propofol-alfentanil-vecuronium-oxygen and either nitrous oxide or room air (FIO2 = 0.30). The rate of propofol infusion was adjusted depending on anaesthetic depth as judged using standard clinical criteria; alfentanil was administered on a weight basis. ⋯ In the nitrous oxide group the mean (SD) interval to spontaneous eye opening was 13.1 (7.3) min compared to 8.1 (4.9) min in the air group (p = 0.01). Similarly, the interval until obtaining a standardised response was 13.5 (5.3) min and 9.8 min (5.4) in the nitrous oxide and air groups, respectively (p = 0.04). The addition of nitrous oxide to propofol-alfentanil-vecuronium anaesthesia does not reduce propofol requirements and prolongs early recovery compared to air.
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Randomized Controlled Trial Comparative Study Clinical Trial
Time course of action and intubating conditions following vecuronium, rocuronium and mivacurium.
The purpose of this study was to compare the time course of action and tracheal intubating conditions of vecuronium, rocuronium and mivacurium in anaesthetised patients. Anaesthesia consisted of thiopentone, fentanyl, N2O/O2 and isoflurane. After a 2 x ED90 dose the first attempt at tracheal intubation was made at 90 s. ⋯ The average onset times of rocuronium (172 s) and vecuronium (192 s) were significantly shorter than that of mivacurium (229 s). The clinical duration and recovery time were significantly shorter after mivacurium (13 and 6 min, respectively) than with vecuronium (33 and 14 min, respectively) and rocuronium (28 and 11 min, respectively). We conclude that rocuronium might be of advantage whenever the interval between the administration of the muscle relaxant and tracheal intubation must be short, whereas mivacurium may be of benefit if fast spontaneous recovery is required.
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Letter Randomized Controlled Trial Comparative Study Clinical Trial
Fentanyl versus morphine for patient-controlled analgesia.
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Randomized Controlled Trial Clinical Trial
Facilitation of laryngeal mask insertion. Effects of lignocaine given intravenously before induction with propofol.
The effects of pretreatment with lignocaine administered intravenously on the insertion of the laryngeal mask airway were investigated in 80 unpremedicated, ASA 1 or 2, adult day-case patients in a randomised, double-blind, placebo-controlled trial. Patients received either intravenous lignocaine 1.5 mg.kg-1 or an equivalent volume of sodium chloride 0.9%. Induction of anaesthesia was achieved with propofol given via a syringe driver at a fixed rate of 600 ml.h-1 until the patient dropped a weighted syringe. ⋯ There were no differences between the lignocaine and control groups with respect to induction dose of propofol, degree of jaw opening, or amount of gagging. Laryngeal mask insertion was facilitated by pretreatment with lignocaine administered intravenously, without an alteration in induction dose of propofol (p < 0.05). Coughing and airway obstruction were both significantly reduced by pretreatment with lignocaine, as was the incidence of failure of insertion requiring deepening of anaesthesia (p < 0.05).
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Randomized Controlled Trial Clinical Trial Controlled Clinical Trial
Evaluation of the influence of movement on saturation readings from pulse oximeters.
This study aimed to develop a protocol for assessing the influence of movement on oxyhaemoglobin saturation readings from pulse oximeters. Thirty-six volunteers took part in the study. In each volunteer, each hand was monitored by both a Nellcor N200 oximeter using a disposable probe and by a Datex Satlite DS103 oximeter using a clip-on finger probe. ⋯ All movements were associated with apparent decreases in oxyhaemoglobin saturation which were statistically significant for two movements with the Nellcor equipment and for four movements with the Datex equipment. Movement was associated with increases in the magnitude of pulse amplitude, but this was not quantitatively associated with magnitude of artefactual changes in saturation. Use of this standardised movement protocol allows quantification of movement artefact from pulse oximeters and should facilitate the development of equipment less affected by movement.