Anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial Retracted Publication
Recovery of post-tetanic count and train-of-four responses at the great toe and thumb.
We have studied the recovery of post-tetanic count and train-of-four responses at the great toe and thumb accelerographically after the administration of vecuronium 0.2 mg.kg-1. Sixty adult patients scheduled for anaesthesia with nitrous oxide and isoflurane were studied. The times to the return of the first post-tetanic twitch were comparable at the great toe and thumb (mean (SD) times: 30.0 (6.5) min and 35.0 (8.5) min, respectively). ⋯ Also, time to the return of the first twitch of the train-of-four did not differ significantly at the great toe and the thumb (47.5 (9.6) min vs. 49.7 (10.5) min). Similarly, time to the return of the second, third and fourth twitches of the train-of-four did not significantly differ at the great toe and the thumb. However, the value of the first twitch of the train-of-four, expressed as a proportion of control twitch, was significantly higher than that at the thumb between 50 min and 110 min after the vecuronium injection, and the train-of-four ratio at the great toe was significantly higher than that at the thumb between 60 min and 100 min after the vecuronium injection.
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Randomized Controlled Trial Clinical Trial
Epidural anaesthesia as a method of pre-emptive analgesia for abdominal hysterectomy.
The effect of pre- versus postincisional epidural blockade without the use of systemic opioids was investigated in a randomised, double-blind study of two groups of 25 patients undergoing abdominal hysterectomy performed under general anaesthesia. The first group received, via a lumbar epidural catheter, 0.9% saline (16 ml) 15 min prior to surgical incision and 0.5% bupivacaine (15 ml) and fentanyl 50 micrograms (1 ml) 15 min prior to skin closure. ⋯ Visual analogue pain scores and patient-controlled morphine consumption were measured at specified times for 48 h. We were unable to detect any significant difference in either of the outcome measures of the two groups and thus were unable to demonstrate that epidural blockade using local anaesthetic and opioid has a pre-emptive effect.
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Randomized Controlled Trial Clinical Trial
Intrathecal diamorphine for analgesia after caesarean section. A dose finding study and assessment of side-effects.
Eighty women undergoing elective Caesarean section under spinal anaesthesia using hyperbaric bupivacaine 0.5% were randomly allocated to receive, in addition, intrathecal diamorphine 0.125, 0.25 or 0.375 mg or saline. Postoperative morphine requirements, measured using a patient-controlled analgesia system, were reduced in a dose-dependent manner by diamorphine. Pain scores were significantly lower at 2 and 6 h following the two larger doses of diamorphine. ⋯ There were no adverse neonatal effects. Intrathecal diamorphine in the present study was found to be safe in doses of up to 0.375 mg following Caesarean section. However, minor side-effects were frequently observed.
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Randomized Controlled Trial Clinical Trial
Requirements for target-controlled infusion of propofol to insert the laryngeal mask airway.
The success rate for insertion of the laryngeal mask airway was assessed in 60 patients using a target-controlled infusion of propofol. Eleven of 15 patients who received a target propofol concentration of 5 micrograms.ml-1 had the laryngeal mask inserted successfully within 3 min of induction of anaesthesia. Fourteen of 15 patients who received 6 micrograms.ml-1 had successful insertion within 3 min and all 15 patients who received 7 micrograms.ml-1 had successful insertion within 3 min. ⋯ The increased success rate of LMA insertion with the higher target propofol concentrations was achieved without major haemodynamic effects in this group of fit patients. However, adverse cardiovascular effects may occur with these doses in elderly or unfit patients. It is important in individual patients to titrate the target propofol concentration to achieve the required clinical endpoint.