Anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Akathisia following low-dose droperidol for antiemesis in day-case patients.
Akathisia has been described following the use of droperidol for antiemetic prophylaxis. In a double-blind, placebo-controlled study, we investigated both the incidence of akathisia and its relationship to the dose of droperidol (0.5 or 1 mg). One hundred and twenty healthy women undergoing day-case gynaecological surgery were anaesthetised with propofol, fentanyl, isoflurane and droperidol according to group. ⋯ Compared to the control group, those women given droperidol 1 mg suffered more restlessness (p = 0.001) and unpleasant restlessness (p < 0.01). No statistical difference could be demonstrated between the two droperidol groups. We conclude that droperidol may commonly cause akathisia and may not, therefore, be an appropriate prophylactic antiemetic for day-case anaesthesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Topical ibuprofen for skin analgesia prior to venepuncture.
The analgesic effect of topical ibuprofen was investigated in ten volunteers. There were no significant differences in visual analogue scale pain scores for pinprick after 15 and 60 min of application of ibuprofen, placebo and EMLA cream. Comparison of visual analogue scale scores for venous cannulation after similar durations of ibuprofen and EMLA creams found significantly (p < 0.014) lower scores for EMLA at 60 min. We do not consider ibuprofen cream to be clinically useful for venous cannulation.
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Randomized Controlled Trial Comparative Study Clinical Trial
The effect of temperature upon pain during injection of propofol.
Propofol has been shown to cause pain on injection. This study investigated the effect of warming propofol to 37 degrees C on the pain of intravenous injection. ⋯ Warming propofol decreased the incidence of pain on injection by 37% (p < 0.001), and also decreased the severity of pain reported by patients (p < 0.001). We conclude that warming propofol to 37 degrees C provides a simple and safe method of reducing the incidence of pain on injection without the addition of other agents.
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Randomized Controlled Trial Comparative Study Clinical Trial
Dose-response and minimum time to satisfactory intubation conditions after mivacurium in children.
We assessed neuromuscular blocking effects and tracheal intubation conditions following mivacurium in 121 anaesthetised children aged 1-10 years. The study was conducted in three parts. Parts 1 and 2 were undertaken during thiopentone-alfentanil-nitrous oxide anaesthesia; neuromuscular blockade was evaluated by recording the force of contraction of the adductor pollicis in response to train-of-four stimulation at 0.1 Hz. ⋯ The times to 90% and 100% depression of control twitch were 1.3 (0.3) and 1.9 (0.5) min; times to 5%, 25%, 75% and 90% recovery were 6.4 (1.0), 8.4 (1.1), 12.5 (1.1) and 14.4 (1.9) min, respectively. Intubation conditions were rated satisfactory in 33/50 children (0.66, 95% confidence interval 0.51-0.79) at 60 s and in 49/50 children (0.98, 95% confidence interval 0.89-1.0) at 90 s (p = 0.0001). Intubation conditions 90 s after mivacurium 0.2 mg.kg-1 were significantly better than those obtained in 10 patients given anaesthetic drugs alone (p = 0.002).
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This review summarises evidence for immunomodulatory effect of drugs administered peri-operatively. The clinical significance of the balance of pro- and anti-inflammatory cytokines may be seen in certain disease states, for example, meningococcal meningitis and Lyme arthritis. This balance may be altered peri-operatively. ⋯ Natural killer cell activity, which is involved in immunity against tumour cells and virally infected cells is transiently depressed by volatile anaesthetic agents and opioids. In contrast catecholamines enhance natural killer cell activity. Whereas decrease in immunoglobulin levels occur peri-operatively, this is not thought to be as a result of drugs at clinically used concentrations but rather due to haemodilution.