Anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Parturient-controlled epidural analgesia during labour: bupivacaine vs. ropivacaine.
In this randomised, controlled study, we compared the hourly dose requirement of ropivacaine 0.125% (group R, n = 16) with bupivacaine 0.125% (group B, n = 16) provided by demand-only (bolus 5 ml, lockout 10 min) parturient-controlled epidural analgesia during labour. The hourly dose requirement was comparable although group R had a lower successful to total demands ratio (p < 0.05). ⋯ No difference in maternal or fetal outcome was detected. We conclude that, at a concentration of 0.125%, ropivacaine and bupivacaine were equally effective when self-administered using this patient-controlled regimen.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of continuous epidural infusion of ropivacaine and sufentanil with intravenous patient-controlled analgesia after total hip replacement.
We assessed the efficacy of an epidural infusion of ropivacaine 0.1% and sufentanil 1 microg x ml(-1), comparing it with intravenous patient-controlled analgesia using piritramide in this prospective, randomised, double-blind study of 24 ASA physical status I-III patients undergoing elective total hip replacement. Lumbar epidural block using ropivacaine 0.75% was combined with either propofol sedation or general anaesthesia for surgery. Epidural infusion and patient-controlled analgesia were started after surgery. ⋯ The piritramide group experienced significantly more adverse events than the epidural group (p < 0.001), especially hypotension (p < 0.01) and vomiting (p < 0.05). Patients in the epidural ropivacaine group were more satisfied with the pain management (p < 0.05). We conclude that the epidural infusion of ropivacaine 0.1% and sufentanil 1 microg x ml(-1) is superior to intravenous opioid by patient-controlled analgesia in preventing pain after total hip replacement, with fewer adverse effects and greater patient satisfaction.
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Randomized Controlled Trial Comparative Study Clinical Trial
Adenotonsillectomy in children: a comparison of morphine and fentanyl for peri-operative analgesia.
This study compared the effectiveness and side-effects of intra-operative fentanyl with fentanyl and morphine for elective adenotonsillectomy in a double-blind study, in 60 children randomly allocated to receive either intravenous fentanyl 1 microg x kg(-1) intra-operatively or intramuscular morphine 100 microg x kg(-1) at induction. All children received a standard anaesthetic induction with intravenous fentanyl 1 microg x kg(-1) and propofol 4-5 mg x kg(-1) and maintenance with oxygen, nitrous oxide and isoflurane. Pain scores, emetic episodes and supplemental morphine requirements were recorded for 24 h postoperatively. ⋯ The incidence of postoperative vomiting was lower in the fentanyl group (p < 0.03) in the first 4 h, but similar by 24 h. Children who received morphine at any time in the first 24 h had more median (range) episodes of vomiting [2 (0-7)] than children receiving fentanyl only [l (0-3); p < 0.03]. Administration of rescue anti-emetics, pain scores in recovery and pain scores over the next 24 h were similar between the two groups.
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Multicenter Study
Mortality associated with anaesthesia: a qualitative analysis to identify risk factors.
From a prospectively defined cohort of patients who underwent either general, regional or combined anaesthesia from 1 January 1995 to 1 January 1997 (n = 869 483), all consecutive patients (n = 811) who died within 24 h or remained unintentionally comatose 24 h after anaesthesia were classified to determine a relationship with anaesthesia. These deaths (n = 119; 15%) were further analysed to identify contributing aspects of the anaesthetic management, other factors and the appropriateness of care. The incidence of 24-h peri-operative death per 10 000 anaesthetics was 8.8 (95% CI 8.2-9.5), of peri-operative coma was 0.5 (0.3-0.6) and of anaesthesia-related death 1.4 (1.1-1.6). ⋯ For inadequate patient monitoring, human factors contributed to 71 (60%) deaths and organisational factors to 48 (40%). Other contributing factors were inadequate communication (30 deaths (25%) for all four aspects of the anaesthetic management) and lack of supervision (particularly for ventilatory management). Inadequate care was delivered in 19 (16%) of the anaesthesia-related deaths with respect to cardiovascular management, in 20 (17%) with respect to ventilatory management, in 18 (15%) with respect to patient monitoring and in 23 (19%) with respect to other anaesthetic management.
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Duration of laryngoscopy must be kept as short as possible to prevent disturbances of oxygenation and ventilation. Because the factors associated with prolonged laryngoscopy are not well known, we studied 1000 patients undergoing tracheal intubation under general anaesthesia to determine the possible effects of their characteristics on the incidence of prolonged laryngoscopy (defined as lasting longer than 15 s). ⋯ Six characteristics were determined as risk factors for a prolonged laryngoscopy: weight > 80 kg [OR 3.7 (95% CI 1.9-7.1)]; tongue protrusion < 3.2 cm [OR 2.0 (1.0-4.2)]; mouth opening < 5 cm [OR 4.3 (2.1-8.9)]; upper incisor length > 1.5 cm [OR 4.2 (2.0-8.6)]; Mallampati class > 1 [OR 10.0 (7.1-14.6)]; and head extension < 70 degrees [OR 7.1 (3.8-13.6)]. The presence of three of these factors predicted prolonged laryngoscopy with a sensitivity of 0.72 and a specificity of 0.91