British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Antiemetic efficacy of prophylactic ondansetron in laparoscopic surgery: randomized, double-blind comparison with metoclopramide.
In a randomized, double-blind study, we have compared the prophylactic antiemetic efficacy of ondansetron with that of metoclopramide in 123 patients undergoing general anaesthesia for day-case gynaecological laparoscopic surgery. The patients received either i.v. ondansetron 4 mg or metoclopramide 10 mg immediately before a standard anaesthetic. ⋯ In those patients with a previous history of postoperative nausea and vomiting, nausea was less severe in those receiving ondansetron compared with those receiving metoclopramide (P < 0.05). We conclude that preoperative prophylactic administration of i.v. ondansetron was superior to metoclopramide in preventing nausea and vomiting after general anaesthesia for day-case gynaecological laparoscopic surgery.
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Randomized Controlled Trial Clinical Trial
Effect of extradural diamorphine on analgesia after caesarean section under subarachnoid block.
We have examined the efficacy, duration of action and side effects of extradural diamorphine alone and in combination with 1:200,000 adrenaline in a randomized, double-blind controlled study of 45 patients who underwent Caesarean section under spinal anaesthesia. Saline 10 ml, diamorphine 2.5 mg in saline 10 ml or diamorphine 2.5 mg in 1:200,000 adrenaline 10 ml were administered via the extradural route at delivery of the baby. ⋯ The addition of adrenaline increased the quality of analgesia 8 h after operation, but had no effect on the total amount of i.m. morphine administered during the first 24 h. The incidence of side effects was similar in all groups.
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Comparative Study
Tracheal intubation in a mannikin: comparison of the Belscope with the Macintosh laryngoscope.
Tracheal intubation carries a risk of accidental oesophageal intubation; this is increased with inexperienced trainees, and in patients with a difficult airway. The recent introduction of an angulated laryngoscope, the Belscope, may permit a better view of the vocal cords and increase the accuracy of orotracheal intubation. To determine how easy it is to learn to use the Belscope compared with the traditional Macintosh laryngoscope, a group of medical students attempted to intubate a mannikin which had been modified to simulate a difficult intubation. Time to intubation was fast with both laryngoscopes, although faster with the Macintosh, but the Belscope produced an unexpected greater incidence of failed intubation.
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Surgical repair of craniosynostosis carries a high risk with large blood losses. Over a 2-yr period, we have managed 115 patients undergoing craniosynostosis repair with peroperative haemodilution to achieve a final PCV of 0.28-0.35. Measurements of PCV allowed calculation of estimated blood losses and transfused volumes in terms of red blood cell mass. ⋯ Peroperative transfusion was satisfactory in 48% of patients and slight overtransfusion was noted in 32%. During the postoperative period, liberal administration of blood led to overtransfusion and possibly unnecessary transfusion in 74% of patients. Because of the well known risks of transmission of infectious disease, strict volume compensation with development of haemodilution and autotransfusion procedures should be used to limit these risks.
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Randomized Controlled Trial Clinical Trial
Lung management during cardiopulmonary bypass: is continuous positive airways pressure beneficial?
It is not clear if the use of continuous positive airway pressure (CPAP) during cardiopulmonary bypass (CPB) improves lung function after cardiac surgery. We have measured alveolar-arterial oxygen partial pressure difference (PAO2-PaO2) in 61 patients undergoing elective coronary artery bypass surgery. ⋯ The time to extubation (P = 0.42) and early extubation (P = 0.87) were not affected by the use of CPAP. The results of this study do not support the use of CPAP during CPB as a mechanism of improving lung function after cardiac surgery.