British journal of anaesthesia
-
Randomized Controlled Trial Comparative Study Clinical Trial
Double-blind comparison of the morphine sparing effect of continuous and intermittent i.m. administration of ketorolac.
The morphine sparing effect of ketorolac 10 mg administered 4-hourly by intermittent i.m. injection was compared with a continuous i.m. infusion in a double-blind, placebo-controlled trial in patients undergoing upper abdominal surgery. During the 48-h postoperative period, each patient was provided with a patient-controlled analgesia (PCA) system which delivered bolus doses of morphine and administered the intermittent i.m. doses automatically via a computer controlled pump. ⋯ In the second 24 h and over the entire 48 h of the study, patients in the continuous group required significantly less morphine than those in the placebo group. The intermittent group used less than the placebo group, but this was not significant.
-
Randomized Controlled Trial Clinical Trial
Pain on injection of propofol: effects of concentration and diluent.
The emulsion formulation of propofol (Diprivan) evokes pain on i.v. injection, although its pH and osmolality are close to those of blood. The pain induced by serial dilutions of propofol in Intralipid and 5% glucose was examined in isolated vein segments and after intracutaneous injection. ⋯ Dilution with 10% Intralipid reduced pain more than that with 5% glucose. We conclude that the intensity of pain after i.v. injection of propofol was related to its free aqueous concentration.
-
Case Reports
Backache after extradural anaesthesia in the postpartum period: dissection of thoracic aneurysm.
We describe a case of postpartum ruptured dissecting aneurysm of the thoracic aorta, unrelated to the anaesthetic management with extradural anaesthesia. This complication is discussed in detail, as the anaesthetist may be the specialist required to respond to the common presenting symptom of severe back pain.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of sufentanil-nitrous oxide anaesthesia with fentanyl-nitrous oxide anaesthesia in geriatric patients undergoing major abdominal surgery.
We have measured haemodynamic changes and plasma concentrations of catecholamines during sufentanil-nitrous oxide and fentanyl-nitrous oxide anaesthesia in a controlled, randomized, double-blind study of 20 geriatric patients (age 65-86 yr) undergoing major abdominal surgery. Fentanyl 7 micrograms kg-1 followed by infusion of 3 micrograms kg-1 h-1 was compared with sufentanil 1 micrograms kg-1 followed by 0.4 micrograms kg-1 h-1. The opioid was supplemented with 60-67% nitrous oxide in oxygen. ⋯ Haemodynamic state was stable during induction and tracheal intubation in both groups, while during stressful operative periods there were increases in mean arterial pressure (17% in the fentanyl group; 11% in the sufentanil group), heart rate (fentanyl 20%, sufentanil 14%) and plasma concentrations of catecholamines (adrenaline: fentanyl 316%, sufentanil 86%; noradrenaline: fentanyl 78%, sufentanil 186%) in both groups. Sufentanil was similar to fentanyl in attenuating the haemodynamic and hormonal responses to surgical stimulation. In two patients in the fentanyl group and three in the sufentanil group, myocardial lactate production was observed temporarily, indicating myocardial ischaemia caused by surgical stress.
-
Randomized Controlled Trial Clinical Trial
Neuromuscular and clinical effects of mivacurium chloride in healthy adult patients during nitrous oxide-enflurane anaesthesia.
We have studied the effects of mivacurium after induction of anaesthesia with alfentanil-propofol in healthy adult oral surgical patients. Anaesthesia was maintained with nitrous oxide and 0.75% (end-tidal) enflurane in oxygen after nasotracheal intubation. Recordings were made of the rectified compound adductor pollicis electromyogram in response to train-of-four (TOF) ulnar nerve stimulation. ⋯ Mean duration of infusion was 58 (3.4) min and mean infusion rate after a 15-min stabilization period was 6.6 (range 2.3-12.9) micrograms kg-1 min-1. On cessation of infusions, spontaneous recovery from T1/Tc 8% (1.0%) to T4:T1 = 0.7 took 17 (1.2) min. Neostigmine 0.04 mg kg-1 or edrophonium 0.75 mg kg-1 evoked recovery from T1/Tc 9% (SEM 1.2% and 1.0%, respectively) to T4:T1 = 0.7 in 11 (0.6) and 8 (0.9) min (both P less than 0.001 vs spontaneous recovery).