British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Antagonism of the hypnotic effect of midazolam in children: a randomized, double-blind study of placebo and flumazenil administered after midazolam-induced anaesthesia.
In a randomized, double-blind study, we administered placebo and flumazenil to 40 healthy Chinese boys, aged 3-12 yr, undergoing circumcision. The children received midazolam 0.5 mg kg-1 orally for premedication and 0.5 mg kg-1 i.v. during induction. After operation the patients were given 0.1 ml kg-1 of a blinded solution followed by 0.05 ml kg-1 min-1 until either they awoke or the 10-ml ampoule of solution was empty. ⋯ There were no cases of resedation, but one child did not awaken for 30 min after i.v. administration of flumazenil 1.0 mg. The mean total dose of flumazenil administered was 0.024 (SD 0.019) mg kg-1. Flumazenil rapidly antagonized midazolam-induced hypnosis in children and was associated with minimal change in cardiorespiratory variables.
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Randomized Controlled Trial Comparative Study Clinical Trial
Adrenaline, fentanyl or adrenaline and fentanyl as adjuncts to bupivacaine for extradural anaesthesia in elective caesarean section.
We have compared the effects of extradural fentanyl and fentanyl plus adrenaline with adrenaline alone as adjuncts to extradural bupivacaine in patients undergoing elective Caesarean section. Forty-five patients were allocated randomly to receive 0.45% bupivacaine 20 ml with adrenaline 4.5 micrograms ml-1, fentanyl 4.5 micrograms ml-1 or adrenaline plus fentanyl (4.5 micrograms ml-1 of each) as supplements. The main outcome measures were time to bilateral analgesia of T6 or higher, need for intraoperative analgesic supplements, observer rating of intraoperative analgesia and patient assessment of analgesia using a 10-cm visual analogue scale. ⋯ Two patients experienced respiratory depression after extradural fentanyl and were given naloxone. Two neonates were also given naloxone. Close supervision is therefore recommended in the early postoperative period when this technique is used.