Anaesthesia
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Randomized Controlled Trial Clinical Trial
Pretreatment with controlled-release morphine for pain after hysterectomy.
In a double-blind randomised study, two dosing regimens for controlled-release morphine tablets were compared against placebo to ascertain the extent of prophylactic postoperative pain control in 51 women undergoing abdominal hysterectomy. One group of patients received controlled-release morphine every 12 h for 2 days before surgery, a second group received a single dose of controlled-release morphine 2 h before surgery and a third group received placebo. Patient-controlled analgesia system demands were compared for the first 38 h after surgery and 10-point pain scores and McGill pain questionnaires were compared for the first 6 postoperative days and at 6 weeks after surgery. ⋯ Pain scores on the third and fourth postoperative days were significantly lower in those who had a single pre-operative dose of controlled-release morphine compared with placebo and those who had been treated with-morphine every 12 h for 2 days (p = 0.043 and 0.024 for third and fourth day respectively). Patient-controlled analgesia demands were also fewer and less variable in those patients receiving the single dose of morphine 2 h before surgery. The study shows a beneficial analgesic effect of a single pre-operative dose of morphine, but shows no benefit for a more prolonged pre-operative dosing regimen.
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Randomized Controlled Trial Clinical Trial
Pre-operative oral administration of morphine in day-case gynaecological laparoscopy.
The analgesic effect of morphine sulphate 10 mg by mouth given pre-operatively on pain after gynaecological laparoscopy was studied in a randomised, prospective, double-blind, placebo-controlled comparison. Two groups of 56 patients were studied one group undergoing diagnostic laparoscopy and the other laparoscopic sterilisation. ⋯ Morphine premedication did not significantly influence postoperative pain as assessed on a visual analogue scale in either group and postoperative opioid consumption was unaffected. Premedication with morphine 10 mg orally does not significantly decrease pain after day-case gynaecological laparoscopy.
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Randomized Controlled Trial Clinical Trial
The effect of glycopyrrolate on postoperative pain and analgesic requirements following laparoscopic sterilisation.
In order to evaluate the contribution of tubal spasm to pelvic pain following laparoscopic sterilisation, we have studied the effect of glycopyrrolate, an anticholinergic agent with antispasmodic properties, on 60 ASA 1 and 2 patients presenting as day-cases for laparoscopic sterilisation using Filshie clips. In a randomised, double-blind, controlled trial, patients received either glycopyrrolate 0.3 mg or saline intravenously prior to induction of anaesthesia. ⋯ Nausea, vomiting and anti-emetic requirements were also reduced though not significantly. We conclude that glycopyrrolate 0.3 mg at induction of anaesthesia is an effective method of improving the quality of recovery after day-case laparoscopic sterilisation using clips.
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Randomized Controlled Trial Clinical Trial
Gas leakage and the laryngeal mask airway. A comparison with the tracheal tube and facemask during spontaneous ventilation using a circle breathing system.
The ability of the laryngeal mask airway, tracheal tube and facemask to provide a leak free seal in a clinical setting was assessed by measuring the minimal fresh gas flows needed in a closed circle system during spontaneous ventilation on 60 subjects. The fresh gas flow was reduced until no spillage occurred from the pop-off valve. This fresh gas flow was taken to represent the sum of gas uptake by the subject and gas leakage from the circuit. ⋯ The fresh gas flow required for the facemask group was significantly higher than that for the laryngeal mask airway or tracheal tube groups (p < 0.01). There was no significant difference between the fresh gas flows required for the tracheal tube and laryngeal mask airway group. We conclude that the laryngeal mask airway provides as good a gas tight seal as a tracheal tube in this context and would be of benefit in reducing anaesthetic gas pollution.
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Randomized Controlled Trial Clinical Trial
Respiratory effects of spinal anaesthesia for caesarean section.
We report the changes observed in a number of pulmonary function tests performed on 36 patients undergoing Caesarean section under spinal anaesthesia. The tests comprised peak expiratory flow, forced expiratory volume in one second, forced vital capacity, forced expiratory volume in one second to forced vital capacity ratio and the maximal mid-expiratory flow. ⋯ These changes persisted for four hours after the induction of spinal anaesthesia. Administration of 35% oxygen by facemask failed to change significantly fetal umbilical vein pH or partial pressure of oxygen.