Anaesthesia
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Randomized Controlled Trial Clinical Trial
Antiemetic efficacy of prophylactic ondansetron in laparoscopic cholecystectomy. A randomised, double-blind, placebo-controlled trial.
The antiemetic efficacy of ondansetron given prophylactically was investigated in a randomised, double-blind, placebo-controlled trial of 63 patients undergoing laparoscopic cholecystectomy. The patients received intravenously prior to anaesthesia either ondansetron 4 mg or placebo. The same standardised general anaesthetic technique was used. ⋯ The proportions of patients given rescue antiemetic medication were 45% and 44%, respectively. No clinically important adverse events were observed. In conclusion, ondansetron given prior to anaesthesia in a dosage of 4 mg did not prevent postoperative nausea and vomiting after laparoscopic cholecystectomy.
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Randomized Controlled Trial Clinical Trial
The use of the McCoy laryngoscope in patients with simulated cervical spine injuries.
We studied the laryngoscopic view in 167 patients with their head and necks held in the neutral position with manual in-line stabilisation and cricoid pressure to simulate the patient with a suspected cervical spine injury. Each patient underwent laryngoscopy using both a McCoy and a Macintosh laryngoscope. The best view obtained by each larngoscope was graded according to standard guidelines. ⋯ It improved the Macintosh grade by 1 grade in 41% and by 2 grades in 8% (p < 0.001). Difficult laryngoscopy, defined as the inability to see the glottis (grade 3 or 4), was found in 56 (33%) with the Macintosh laryngoscope and only eight (5%) (P < 0.001) with the McCoy laryngoscope. We suggest that patients with a suspected cervical spine injury and a full stomach should be intubated using a McCoy in preference to a Macintosh laryngoscope.
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Malignant hyperthermia susceptibility is genetically heterogeneous. The ryanodine receptor gene on the long arm of chromosome 19 represents an important candidate gene but not all families with malignant hyperthermia demonstrate ryanodine receptor mutations or linkage to this region of 19q. Linkage to chromosome 17 in the region of the adult muscle sodium channel alpha subunit gene has been suggested in some families; others are not linked to either of these loci. ⋯ We have performed linkage analysis in a large family group with malignant hyperthermia in which the in vitro muscle contracture test had been carried out using the procedure standardised by the European Malignant Hyperthermia Group. None of the published ryanodine receptor gene mutations associated with malignant hyperthermia susceptibility were detected in affected individuals but linkage to intragenic ryanodine receptor markers strongly suggest that this gene is involved in malignant hyperthermia susceptibility in this family. This enabled accurate predictive testing by DNA analysis in 11 untested subjects at 50% risk.
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The hypothesis that anaesthetic uptake during maintenance of anaesthesia is related to cardiac output was tested on 21 patients undergoing cardiac surgery. Using a computer-controlled closed breathing system, enflurane was administered to maintain an end-expired concentration of 1%. ⋯ A clear qualitative but not quantitative relationship was demonstrated. Changes in anaesthetic requirements at a constant end-expired concentration are a better guide to changes in cardiac output than changes in end-expired carbon dioxide with constant ventilation in patients undergoing cardiac surgery.
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Randomized Controlled Trial Comparative Study Clinical Trial
Anaesthesia for day-care arthroscopy. A comparison between desflurane and isoflurane.
A study was undertaken to compare desflurane- and isoflurane-based anaesthesia in patients undergoing day-care arthroscopic surgery. Anaesthesia was induced with propofol 2-3 mg.kg-1 and a laryngeal mask airway was inserted after loss of the eyelash reflex. Patients were then randomly divided into two groups to receive maintenance anaesthesia with either isoflurane or desflurane delivered in oxygen and nitrous oxide. ⋯ The mood adjective checklist showed that patients in the isoflurane group had a greater total mood score and were more calm than those in the desflurane group; this was particularly evident 2 h after anaesthesia. The discharge times were similar for the two groups. Desflurane is a satisfactory alternative to isoflurane for day care anaesthesia.