British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Adrenocortical hormone concentrations in children during cardiopulmonary bypass with and without pulsatile flow.
Plasma cortisol and ACTH concentrations were measured in two groups of children (aged 1-16 yr). Ten children underwent routine (non-pulsatile) cardiopulmonary bypass and 10 underwent pulsatile bypass under moderate hypothermia (28-32 degrees C). ⋯ By 24 h the concentrations of both hormones had declined towards baseline values. There were no significant differences between the groups.
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Randomized Controlled Trial Clinical Trial
Effect of nifedipine on cardiovascular responses to laryngoscopy and intubation.
The efficacy of sublingual nifedipine in attenuating the pressor responses to laryngoscopy and intubation was studied in 40 patients undergoing elective surgery. Anaesthesia was induced with thiopentone 5.5 mg kg-1 i.v. and tracheal intubation was facilitated with suxamethonium 1.5 mg kg-1 i.v. ⋯ The increases in arterial pressure and rate-pressure product were reduced in nifedipine treated patients (P less than 0.001). Heart rate increased significantly in both groups immediately after intubation.
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Randomized Controlled Trial Clinical Trial
Nitrous oxide and day-case laparoscopy: effects on nausea, vomiting and return to normal activity.
Patients admitted for day-case laparoscopy were assigned randomly to receive nitrous oxide-oxygen or oxygen, with enflurane, during a standard anaesthetic technique. Postoperative morbidity, in particular nausea and vomiting, and ability to resume normal activity were assessed over the ensuing 48 h. Supplementary administration of propofol during the operative procedure was required significantly more often (P less than 0.05) in the absence of nitrous oxide. ⋯ The incidence and severity of nausea over the 48 h following operation was similar in both groups. There was no difference in analgesic or anti-emetic requirements before discharge and the time taken to resume normal activity was similar. It is concluded that nitrous oxide may be avoided readily in day-case laparoscopy without affecting postoperative morbidity or time taken to return to "street fitness" and normal activity.
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Randomized Controlled Trial Clinical Trial
Influence of extradural and general anaesthesia on natural killer cell activity and lymphocyte subpopulations in patients undergoing hysterectomy.
The effect of hysterectomy was studied on natural killer (NK) cell activity, the distribution of lymphocyte subpopulations, and the endocrine stress response in 16 patients allocated to receive extradural analgesia S5-T4 (group I) or neuroleptanaesthesia (NLA) (group II). In group II a significant decrease in NK cell activity was found after operation for at least 3 days, while surgery during extradural analgesia did not induce significant changes. ⋯ Compared with group II, extradural analgesia significantly reduced the cortisol and noradrenaline response to surgery, while the adrenaline response in both groups was abolished. The results suggest that the decrease in NK cell activity and alterations in lymphocyte subsets induced by surgery and general anaesthesia can be prevented to a certain degree by extradural analgesia.
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Comparative Study
Spinal analgesia with hyperbaric bupivacaine: influence of age.
The effects of age were investigated on characteristics of spinal analgesia with hyperbaric bupivacaine in 38 younger patients (less than 50 yr: group I), and 48 older patients (greater than 80 yr: group II). Four millilitre of 0.375% bupivacaine in 2.5% dextrose was injected via the L3-4 space in a lateral position, and the patients were immediately turned supine. In group II, the time to maximum spread was significantly shorter, and the sensory spinal blockade higher (one dermatome) than in group I. ⋯ Complete motor blockade of the lower limbs developed most rapidly in group II, while duration of all degrees of motor blockade did not differ significantly with age. Because of great individual variation, the clinical significance of such differences is limited. In the older group, there was a greater decrease in systolic arterial pressure from resting values, despite rapid infusion of lactated Ringer's solution.