Anaesthesia
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Randomized Controlled Trial Comparative Study
A randomised single blinded study of the administration of pre-warmed fluid vs active fluid warming on the incidence of peri-operative hypothermia in short surgical procedures.
We compared the effect of delivering fluid warmed using two methods in 76 adult patients having short duration surgery. All patients received a litre of crystalloid delivered either at room temperature, warmed using an in-line warming device or pre-warmed in a warming cabinet for at least 8 h. ⋯ The administration of 1 l warmed fluid to patients having short duration general anaesthesia results in higher postoperative temperatures. Pre-warmed fluid, administered within 30 min of its removal from a warming cabinet, is as efficient at preventing peri-operative hypothermia as that delivered through an in-line warming system.
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Randomized Controlled Trial
Optimal timing for the administration of intranasal dexmedetomidine for premedication in children.
Previous studies have shown that 1 μg.kg(-1) intranasal dexmedetomidine produces significant sedation in children aged between 2 and 12 years. This investigation was designed to evaluate the onset time. One hundred children aged 1-12 years of ASA physical status 1-2 undergoing elective surgery were randomly allocated to five groups. ⋯ Overall 62% of the children who received intranasal dexmedetomidine had satisfactory sedation at the time of cannulation. The median (95% CI) time for onset of sedation was 25 (25-30) min. The median (95% CI) duration of sedation was 85 (55-100) min.
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Randomized Controlled Trial
Optimal effect-site concentration of remifentanil for preventing cough during emergence from sevoflurane-remifentanil anaesthesia.
This randomised, double-blinded, controlled trial was designed to identify the optimal dose of remifentanil for cough suppression without adverse effects during emergence from sevoflurane-remifentanil anaesthesia for thyroidectomy. One hundred and four patients were randomly assigned to maintain target effect-site concentrations of remifentanil at 0 (control group), 1.0 (remifentail 1 group), or 1.5 ng.ml(-1) (remifentanil 1.5 group) during emergence. The incidence of coughing was lower in the remifentanil 1.5 group (31%) than in the control group (74%) or remifentanil 1 group (63%) (p = 0.0004). ⋯ Haemodynamic changes were reduced, but emergence time and stay in the post-anaesthesia care unit was prolonged in the remifentanil 1.5 group. Maintaining the remifentanil effect-site concentration at 1.5 ng.ml(-1) during emergence from sevoflurane-remifentanil anaesthesia reduces the incidence and severity of coughing without serious adverse events and may provide haemodynamic stability in patients undergoing thyroidectomy. However, awakening may be delayed.
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Randomized Controlled Trial
Analgesic efficacy of intracapsular and intra-articular local anaesthesia for knee arthroplasty.
The optimal site for wound delivery of local anaesthetic after total knee arthroplasty is undetermined. Sixty patients having total knee arthroplasty received intra-operative infiltration analgesia with ropivacaine 0.2% and were then were randomly assigned to receive either intracapsular or intra-articular catheters with 20 ml ropivacaine 0.5% given at 6 h and again at 24 h, postoperatively. ⋯ Maximum pain relief (median (IQR [range])) at rest observed in the 3 h after the 6 and 24 h postoperative injections was 17 (7-31 [0-80]) and 10 (4-27 [0-50]) p = 0.27 for 6-9 h; and 17 (7-33 [0-100]) and 13 (3-25 [0-72]) p = 0.28 for 24-27 h, for intracapsular and intra-articular, respectively. Intracapsular local anaesthetic has similar analgesic efficacy to intra-articular after total knee arthroplasty.
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Randomized Controlled Trial
Potency and recovery characteristics of rocuronium mixed with sodium bicarbonate.
Sodium bicarbonate may be added to rocuronium to decrease pain on injection. However, this mixture may result in the formation of carbon dioxide bubbles. We investigated whether the addition of sodium bicarbonate to rocuronium alters neuromuscular blockade, in 120 patients randomly assigned to receive rocuronium mixed with saline or bicarbonate 8.4%, either in varying doses (for dose-response measurements; 60 patients) or a fixed dose of 600 μg.kg(-1) (for time-course measurements; 60 patients). ⋯ The mean (SD) onset times of rocuronium 600 μg.kg(-1) were 3.6 (0.6) and 2.7 (0.5) min in the corresponding groups, respectively (p < 0.001). The mean (SD) times to 95% recovery were 35.8 (5.8) and 47.9 (7.1) min, respectively (p < 0.001). We conclude that the mixing of sodium bicarbonate with rocuronium enhances the potency, shortens the onset and prolongs the duration of action.