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
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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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.
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Comparative Study
The importance of the expiratory pause. Comparison of the Mapleson A, C and D breathing systems using a lung model.
A physical lung model simulating spontaneous respiration was used to investigate the influence of the respiratory pattern on the efficiency of the Mapleson A, C and D breathing systems. It is shown that the Mapleson A system is always the most efficient breathing system and that its performance is relatively independent of the respiratory pattern. When the expiratory pause is minimal, the Mapleson C system is almost as efficient as the Mapleson A, but becomes ever less efficient as the expiratory pause increases. ⋯ With a longer expiratory pause, this system's efficiency approaches that of the Mapleson A. The experimental results are compared with predictions generated by a mathematical model. There is good agreement between the two, validating the mathematics used.