Anaesthesia
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Randomized Controlled Trial Clinical Trial
Unwanted effects of morphine-6-glucoronide and morphine.
The active metabolite of morphine, morphine-6-glucuronide (M6G), may have fewer unwanted effects than morphine. We randomly allocated 144 women to receive either M6G or morphine as part of general anaesthesia for day case gynaecological laparoscopy. The incidence of nausea, vomiting, pain, sedation and skin rash, and severity of nausea, pain and sedation after surgery were recorded by direct observation in hospital, and by questionnaire until the next morning. ⋯ The next morning, patients in the morphine group remained sleepier, but the incidence of nausea was similar for the two groups. M6G appears to have a better toxicity profile than morphine. More efficacy studies are needed to define accurately the analgesic potency of systemically administered M6G.
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Randomized Controlled Trial Clinical Trial
The effect of auricular acupuncture on anaesthesia with desflurane.
In most acupuncture studies it is difficult or even impossible to conduct a truly double-blind trial. However, this is possible when treatments are carried out on anaesthetised patients. Because acupuncture provides analgesia, we tested the hypothesis that needle stimulation of a combination of four ear acupoints would significantly reduce anaesthetic requirement. ⋯ Anaesthetic requirement, determined by the Dixon up-and-down method, was defined by the average desflurane concentration that prevented purposeful movement of the extremities in response to noxious electrical stimulation. Volunteers required a greater desflurane concentration to prevent movement on the control than on the acupuncture day: 4.9 (0.7; SD) vs. 4.4 (0.8) vol. %, p = 0.003. Acupuncture thus reduced anaesthetic requirement by 8.5 (7)%.
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Randomized Controlled Trial Clinical Trial
Combined use of esmolol and nicardipine to blunt the haemodynamic changes following laryngoscopy and tracheal intubation.
We examined the effect of different combinations of esmolol and nicardipine upon the circulatory response to tracheal intubation. One hundred patients were randomly allocated into five groups of twenty to receive pretreatments of saline or different combinations of esmolol (0.5 or 1.0 mg x kg(-1)) and nicardipine (15 or 30 microg x kg(-1)). Significant tachycardia persisted over a 5-min period after intubation in all five groups compared with baseline levels (p < 0.05). Patients receiving esmolol 1.0 mg x kg(-1) and nicardipine 30 g x kg(-1) showed no significant change in systolic blood pressure after tracheal intubation compared with baseline and significant lower peak systolic blood pressure than those receiving saline (p = 0.023).
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Letter Randomized Controlled Trial Comparative Study Clinical Trial
The two different types of Macintosh laryngoscope blades.
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Submental tracheal intubation is a simple, quick and effective alternative to oral and nasal tracheal intubation or tracheostomy in the surgical management of selected patients with craniomaxillofacial injuries. It has a low morbidity and it does not impede the surgical field, allowing for temporary maxillo-mandibular fixation (jaw wiring) intra-operatively, and nasal assessment, manipulation and bone grafting, either simultaneously or as an independent procedure. We report 12 cases utilizing this technique in this retrospective study, this includes 11 patients with mid-facial fractures and associated base of skull fractures, and one patient who underwent an elective Le Fort III advancement. The techniques and indications for submental tracheal intubation are described.