Anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Prevention of nausea and vomiting after day case gynaecological laparoscopy. A comparison of ondansetron, droperidol, metoclopramide and placebo.
We have compared the efficacy of ondansetron, metoclopramide, droperidol and placebo in the prevention of postoperative nausea and vomiting in 118 day stay patients undergoing laparoscopic gynaecological procedures. All received a standardised general anaesthetic of fentanyl, propofol, nitrous oxide in oxygen and isoflurane. Three to five min before induction of anaesthesia, patients were allocated to receive ondansetron 4 mg, metoclopramide 10 mg, droperidol 1 mg or placebo in a randomised, double-blind manner. ⋯ The incidence of emesis was lower (p = 0.063) and time to first oral fluids was shorter (p < 0.05) in the ondansetron group. Oral analgesic requirements were significantly greater in the ondansetron group over the 48 h study period. Two patients, one each in the placebo and metoclopramide groups, had to remain in hospital overnight because of persistent emetic symptoms.
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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 Clinical Trial
Analgesia following day-case knee arthroscopy--the effect of piroxicam with or without bupivacaine infiltration.
Sixty patients presenting for day-case arthroscopy of the knee under general anaesthesia were studied. Patients were randomly allocated to receive, in addition to intramuscular piroxicam 20 mg, either bupivacaine 0.25% 20 ml applied locally to the knee at the end of the procedure (n = 30) or no further intra-operative analgesia (n = 30). ⋯ A higher proportion of patients in the piroxicam-only group required supplemental analgesia before discharge from hospital. The combination of piroxicam and bupivacaine provided superior analgesia to piroxicam alone.
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Eleven brain-dead organ donors were studied during surgery. Plasma levels of adrenaline and noradrenaline were measured before and after skin incision, upon sternotomy and 15, 30 and 45 min thereafter. ⋯ Plasma catecholamines increased promptly with the onset of surgical stimuli. We conclude that surgical stress can evoke an excessive rise of plasma adrenaline and noradrenaline and thus could impair allograft function.
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We performed a prospective study in our teaching hospital to determine the demand for a High Dependency Unit where none had existed before. An admission criteria protocol was designed for medical and surgical patients and this was used in an intense surveillance of 22 acute wards over 2 weeks. It was predicted that a high dependency unit of eight beds would operate to capacity 50% of the time. An analysis of this type over a short period of time using similar admission criteria could be used to assist in the prediction of the necessary size of a High Dependency Unit facility in any hospital.