British journal of anaesthesia
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Clinical Trial Controlled Clinical Trial
Neuromuscular and cardiovascular effects of mivacurium chloride (BW B1090U) during nitrous oxide-fentanyl-thiopentone and nitrous oxide-halothane anaesthesia.
Seventy-two adult surgical patients were studied to compare neuromuscular and cardiovascular effects of mivacurium chloride during nitrous oxide-fentanyl-thiopentone (BAL group) or nitrous oxide-halothane (HAL group) anaesthesia. Eighteen patients in the BAL group received an initial bolus of mivacurium, either the ED25 (n = 9) or the ED50 (n = 9) (0.03 and 0.05 mg kg-1). These doses were based on the assumption that the slope of the dose-response curve during nitrous oxide-opioid anaesthesia would be approximately the same as the slope of the neuromuscular response from the first human studies with mivacurium. ⋯ With the 0.15-mg kg-1 dose, time to 95% recovery was prolonged significantly in the HAL group (30.0 (SEM 1.4) min) compared with the BAL group (24.1 (1.5) min). Recovery index from 25% to 75% recovery was also prolonged significantly in the HAL group (7.0 (0.4) min) compared with the BAL group (5.4 (0.4) min). There were no significant haemodynamic changes in groups given mivacurium doses up to and including 2 x ED95 by bolus i.v. administration.
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Randomized Controlled Trial Clinical Trial
Depth and duration of skin analgesia to needle insertion after topical application of EMLA cream.
We have determined the depth and duration of analgesia to needle insertion after topical application of EMLA cream (Eutectic Mixture of Local Analgesics). EMLA was applied for 30, 60, 90 and 120 min and the sensory and pain threshold depths were determined before analgesia (1.0 and 1.9 mm, respectively) and up to 4 h after the cream was removed from the skin. ⋯ For application times shorter than 120 min, the depth of analgesia increased during the period after removal of the cream. This suggests new guidelines for the use of this topical analgesic.
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Randomized Controlled Trial Clinical Trial
Isoflurane sedation for patients undergoing mechanical ventilation: metabolism to inorganic fluoride and renal effects.
The metabolism and renal effects of isoflurane sedation were studied for 24 h in patients undergoing mechanical ventilation. Forty-six patients admitted to our intensive therapy unit were allocated randomly to receive either 0.1-0.6% isoflurane or midazolam 0.01-0.2 mg kg-1 h-1 for sedation. ⋯ Serum electrolyte, urea and creatinine concentrations, and urine output rates during and after sedation in patients who received isoflurane were similar to those who received midazolam. We conclude that, following isoflurane sedation for up to 24 h, metabolism to inorganic fluoride is insufficient to cause clinical renal dysfunction.
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Randomized Controlled Trial Comparative Study Clinical Trial
Spinal anaesthesia in young patients using a 29-gauge needle: technical considerations and an evaluation of postoperative complaints compared with general anaesthesia.
One hundred patients aged 18-49 yr, undergoing elective arthroscopy of the knee joint, were allocated randomly to either spinal anaesthesia using a 29-gauge spinal needle or general anaesthesia. Dural puncture was considered difficult in 18% of the patients receiving spinal anaesthesia. In three patients (6%) it was necessary to supplement the spinal anaesthetic with general anaesthesia. ⋯ This headache was of short duration and disappeared without treatment. Spinal anaesthesia caused more backache than general anaesthesia, otherwise the frequency of postoperative complaints was the same or lower. Ninety-six percent of the patients receiving spinal anaesthesia would prefer the same anaesthetic for a similar procedure in the future.
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Randomized Controlled Trial Clinical Trial Controlled Clinical Trial
Effect of nicardipine on the cardiovascular response to tracheal intubation.
We studied the cardiovascular responses to laryngoscopy and intubation in 30 patients who received nicardipine 15 micrograms kg-1 or 30 micrograms kg-1, or saline placebo 60 s before the start of laryngoscopy. Anaesthesia was induced with thiamylal 5 mg kg-1 i.v. and tracheal intubation was facilitated with vecuronium 0.2 mg kg-1. Patients receiving saline showed a significant increase in mean arterial pressure (MAP) and rate-pressure product (RPP) associated with tracheal intubation. The increases in MAP and RPP following tracheal intubation were reduced in both groups of patients who received nicardipine.