Anaesthesia
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Randomized Controlled Trial Clinical Trial
The prevention of postoperative nausea and vomiting using a combination of ondansetron and droperidol.
We have studied the effect of combination antiemetic therapy (ondansetron and droperidol) with morphine delivered by patient-controlled analgesia following major gynaecological surgery. Sixty patients were randomly allocated to one of three treatment regimens; ondansetron alone (4 mg bolus and 0.13 mg.ml-1 in the morphine solution), droperidol alone (1.25 mg bolus and 0.05 mg.ml-1 in the morphine solution), or both drugs in combination. ⋯ There was no difference between the regimens from 12 to 18 h. We conclude that a combination of ondansetron and droperidol added to morphine in a patient-controlled analgesia system reduces postoperative nausea to a greater extent than treatment with either drug alone following major gynaecological surgery.
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Randomized Controlled Trial Clinical Trial
Lung aeration. The effect of pre-oxygenation and hyperoxygenation during total intravenous anaesthesia.
We have investigated the effect of pre-oxygenation and hyperoxygenation (an increase in inspired oxygen fraction from 0.4 to 1.0 after induction of general anaesthesia) on aeration and atelectasis formation in the lungs during total intravenous anaesthesia. Twenty-seven consecutive patients were randomly allocated to group 1 (with pre-oxygenation), group 2 (without pre-oxygenation), or group 3 (hyperoxygenation). Lung aeration was investigated by means of spiral computed tomography. ⋯ In group 1 larger areas of atelectasis were found in the basal parts of the lungs compared to group 2. In group 3 a significant increase in atelectatic areas with a corresponding reduction in areas with reduced aeration occurred at the bases of the lungs. The considerable increase in atelectasis associated with pre-oxygenation and its rapid appearance during hyperoxygenation suggest that these procedures should be used with caution.
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Back pain and minor neurological symptoms are commonly experienced postpartum, often being attributed to non-specific causes such as maternal obstetric factors, or the use of epidural analgesia. We report a case in which neurological problems associated with a prolapsed intervertebral disc occurred after epidural analgesia in labour and a normal vaginal delivery.
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The prognostic value of serial measurements of serum albumin concentration during the first 72 h after admission to a general adult intensive care unit was retrospectively reviewed in 348 consecutive critically ill patients over a one year period. The accuracy of the admission APACHE II (Acute Physiology And Chronic Health Evaluation) score in correctly predicting patient outcome was compared with the serum albumin concentration measured at different times after intensive care unit admission. Multiple logistical regression analyses were performed to evaluate whether combining APACHE II and serum albumin into a unified risk index improved prognostic accuracy. ⋯ However, serum albumin measured after 24 h was as accurate as the admission APACHE II score in correctly classifying patients according to outcome. There was a good correlation between the admission APACHE II score and serum albumin measured after 24 h but not between the admission APACHE II and the admission serum albumin. Combining the APACHE II score and serial albumin concentrations into a unified risk of death equation did not improve the accuracy of outcome prediction.
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The changes occurring in total respiratory system, lung and chest wall mechanics, lung volume and gas-exchange during abdominal insufflation with carbon dioxide for laparoscopic cholecystectomy were studied. Using the technique of rapid airway occlusion during constant flow inflation together with an oesophageal balloon, we computed compliance and maximum resistance of the respiratory system, subsequently apportioning it into its lung and chest wall components. Maximum resistance of the respiratory system was further divided into airway resistance and the viscoelastic properties of the lung and the chest wall. ⋯ Tidal volume, respiratory rate, inspiratory flow and the fraction of inspired oxygen were similar in both groups and maintained constant during the procedure. We found that abdominal carbon dioxide insufflation caused: a reduction in compliance of the respiratory system (both lung and chest wall components) and of functional residual capacity; a marked increase in the maximum resistance of the respiratory system (mainly due to increases in the viscoelastic properties of the lung and chest wall); no change in oxygenation, but an increase in the end-tidal carbon dioxide tension (which was correlated closely with the arterial carbon dioxide tension). These changes were not affected by the duration of anaesthesia.