British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Preoperative sedation before regional anaesthesia: comparison between zolpidem, midazolam and placebo.
The quality of premedication induced by oral midazolam and zolpidem, a new imidazopyridine hypnotic, was assessed in a controlled, double-blind study in 93 patients undergoing elective surgery under spinal or extradural anaesthesia. The patients were allocated randomly to three groups. Each group received the same treatment twice at two different doses. ⋯ There was a comparable incidence of anterograde amnesia with zolpidem and midazolam, but the onset was shorter after zolpidem. Side effects were comparable in the three groups. Zolpidem is an effective hypnotic with a rapid onset and short duration of action which may be an alternative to midazolam for premedication.
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Randomized Controlled Trial Comparative Study Clinical Trial
Hormonal responses to cardiac surgery: effects of sufentanil, somatostatin and ganglion block.
We have investigated the effect of the addition of somatostatin and trimetaphan to sufentanil 20 micrograms kg-1 on the hormonal responses to cardiac surgery and compared the changes with a control group receiving sufentanil and sodium nitroprusside. Eighteen patients undergoing elective valve replacement surgery were studied. Patients who received somatostatin and trimetaphan in addition to sufentanil had significantly smaller serum growth hormone and plasma glucagon concentrations compared with those who received sufentanil and sodium nitroprusside. ⋯ There were no significant differences in catecholamine concentrations between the two groups. There was no effect of the additional inhibition of glucagon and growth hormone on circulating concentrations of glucose and lactate, but plasma concentrations of non-esterified fatty acids increased significantly. Thus the addition of somatostatin increased the suppression of the hormonal response to cardiac surgery by sufentanil.
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Randomized Controlled Trial Clinical Trial
Extradurals and shivering: effects of cold and warm extradural saline injections in volunteers.
We tested the hypothesis that cooling the extradural space may provoke shivering, by giving three 80-ml extradural injections of warm (39.8 +/- 1.2 degrees C) or cold (17 +/- 2.2 degrees C) saline to four healthy volunteers, whilst recording central temperature and electromyographic activity from four muscles. The first injection (always cold) did not induce shivering in any of the subjects. The second and third injections, randomly cold or warm, were given after induction of shivering with cold blankets, but had no detectable effects on the intensity of shivering. This suggests that shivering in extradural anaesthesia does not result solely from cooling of the extradural space.
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One hundred percent carbon dioxide was administered accidentally to a child aged 21 months during anaesthesia; this was caused by unauthorized filling of an oxygen cylinder with carbon dioxide. Cardiac arrest ensued, but was detected and treated promptly and no neurological deficit was detectable following recovery. The case demonstrates a typical preventable anaesthetic mishap and emphasizes the importance of monitoring oxygen supply and delivery.
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Randomized Controlled Trial Clinical Trial
Potency of propofol for loss of consciousness after a single dose.
A dose-response curve for loss of consciousness after administration of propofol was obtained using 56 unselected, premedicated patients presenting for surgery. Propofol was given in doses according to the calculated lean tissue mass (LTM) of the patient. ⋯ Using probit analysis, the ED50 for propofol was found to be 1.34 mg/kg of LTM and the ED95 was found to be 2.56 mg/kg of LTM. Comparison with previously published data for thiopentone showed propofol to be approximately twice as potent as thiopentone at ED50 and the slope of its dose-response curve to be shallower than that of thiopentone.