Anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of the infusion pharmacokinetics and pharmacodynamics of cisatracurium, the 1R-cis 1'R-cis isomer of atracurium, with atracurium besylate in healthy patients.
We have compared the pharmacokinetics of cisatracurium with atracurium when given by bolus dose followed by continuous infusion. Twenty healthy patients were anaesthetised with thiopentone, midazolam, fentanyl and 70% nitrous oxide in oxygen. Ten patients (Group C) were randomly allocated to receive cisatracurium 0.1 mg.kg-1 and 10 patients (Group A) were given atracurium 0.5 mg.kg-1. ⋯ The different isomer groups of atracurium have different pharmacokinetics, the trans-trans group having the highest clearance (1440 ml.min-1) and the cis-cis group the lowest (499 ml.min-1). The clearance of cisatracurium (425 ml.min-1) is less than that of cis-cis atracurium and its elimination half-life is longer (34.9 min and 21.9 min, respectively). The plasma concentration of laudanosine after cisatracurium was one-fifth of that after atracurium.
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Randomized Controlled Trial Clinical Trial
The anti-emetic efficacy of a combination of ondansetron and droperidol.
The anti-emetic efficacy of a combination of ondansetron 8 mg with either droperidol 0.75 mg or 1.25 mg given prophylactically was studied in a randomised blinded trial of 94 female inpatients with a previous history of postoperative nausea and vomiting and scheduled to have laparoscopic surgery. A standardised general anaesthetic technique was used for all patients. The mean estimated risk of postoperative sickness according to predictive patient characteristics was 65% for both treatment groups. ⋯ No serious adverse events were observed. Ondansetron in combination with droperidol 0.75 mg resulted in less drowsiness than in combination with 1.25 mg (p = 0.03). In conclusion, a prophylactic combination treatment of ondansetron 8 mg with a small dose of droperidol was clinically effective and well tolerated for the prevention of postoperative nausea and vomiting after laparoscopic surgery in patients with a high probability of nausea and vomiting.
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Comparative Study Clinical Trial Controlled Clinical Trial
A comparison of intercuff and single cuff techniques of intravenous regional anaesthesia using 0.5% prilocaine mixed with technetium 99m-labelled BRIDA.
Intravenous regional anaesthesia of the upper limb is a widely used technique first described by Bier in 1908. The exact site of action of injected local anaesthetic has not been determined. We have performed intravenous regional anaesthesia on volunteers using prilocaine mixed with technetium 99m-labelled 2,4,6 trimethyl-3-bromo iminodiacetic acid. ⋯ The onset of action was similar for both techniques. The local anaesthetic was mainly retained in the antecubital fossa in both techniques but in the 'normal' technique, the local anaesthetic subsequently showed some retrograde spread. This would suggest that the main site of action of local anaesthetic used for intravenous regional anaesthesia is the larger nerves in the vicinity of the antecubital fossa.
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Randomized Controlled Trial Clinical Trial
The effect of cricoid pressure and neck support on the view at laryngoscopy.
Fifty female patients were studied to compare the view of the larynx at direct laryngoscopy under general anaesthesia with and without cricoid pressure applied. We also compared the view using the standard technique of cricoid pressure with that using cricoid pressure in an upward and backward direction and further investigated whether these views were improved with a firm foam rubber neck support. The order in which the types of cricoid pressure were applied was randomised and also blinded with a drape over the neck. ⋯ Both types of cricoid pressure applied without neck support were more likely to give a better view than no cricoid pressure (p < 0.01) and cricoid pressure in an upward and backward direction was more likely to give a better view at laryngoscopy than the standard technique (p < 0.01). Neck support during the standard technique of cricoid pressure did not improve the view of the larynx at laryngoscopy. Cricoid pressure is likely to improve the view at laryngoscopy which may be further improved by applying it in an upward and backward direction.
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We report our experience with the McCoy levering laryngoscope in 48 patients who were a Cormack and Lehane grade 3 or grade 4 view at direct laryngoscopy. The view with the blade in neutral position was grade 3 in 39 patients and grade 4 in nine patients. ⋯ The McCoy laryngoscope is a useful tool to aid intubation in about half of patients who are a grade 3 view at laryngoscopy. Our experience indicates it is unlikely to improve a grade 4 view.