British journal of anaesthesia
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Case Reports
Use of esmolol in the postbypass management of hypertrophic obstructive cardiomyopathy.
In patients suffering from hypertrophic obstructive cardiomyopathy (HOCM), any catecholamine release during anaesthesia may aggravate the severity of the outflow tract obstruction and compromise cardiac output. In this event the situation may be improved by beta block. Esmolol, an ultra-short-acting beta-blocker (half-life 9 min) appears to be a suitable agent for this purpose. We describe its use in the perioperative management of a patient who underwent surgical correction of HOCM.
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Randomized Controlled Trial Comparative Study Clinical Trial
Preoperative drinking does not affect gastric contents.
We have compared the effect of allowing free clear fluids until the time of oral premedication with conventional preoperative fasting. In a prospective, randomized trial, the residual volume and pH of gastric contents after induction of anaesthesia were measured in 100 elective surgical patients allocated randomly to a group in whom the intake of free clear fluids up to the time of premedication was measured (mean 388 ml in 6 h before surgery) or a control group who were fasted for 6 h. ⋯ Problems with aspiration or regurgitation were not encountered. We believe that allowing elective surgical patients to drink clear fluids until 2 h before anaesthesia may enhance patient comfort without compromising safety.
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Randomized Controlled Trial Clinical Trial
Intra-articular morphine for pain relief after anterior cruciate ligament repair.
We have performed a randomized, double-blind controlled study in patients undergoing elective anterior cruciate ligament repair, to assess the effect of intra-articular morphine on postoperative pain. The morphine group (n = 11) received morphine 5 mg in saline 25 ml and the control group (n = 9), saline 25 ml intra-articularly. Patients in the morphine group had significantly smaller pain scores throughout the 24-h postoperative period compared with those in the control group (P < 0.05). There was less requirement for supplementary analgesics in the morphine group.
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Randomized Controlled Trial Clinical Trial
Nitrous oxide-mediated activation of the EEG during isoflurane anaesthesia in patients.
We have studied the effects of nitrous oxide on EEG burst suppression patterns during stable isoflurane anaesthesia in 13 ASA I patients. After induction of anaesthesia with propofol, the concentration of isoflurane was increased with continuous EEG monitoring to burst suppression level (mean end-tidal concentration of isoflurane, 1.7 (SD 0.2)%), and kept constant during the study. During surgery, isoflurane in air and oxygen (FIO2 0.35), or isoflurane in 65% nitrous oxide in oxygen were given to each patient for 30 min, in random order. ⋯ The proportion of EEG suppression time was measured after a washin or washout period of at least 15 min for nitrous oxide. There was a significant decrease in the proportion of EEG suppression time (from 69.5 to 43.7%) when air was replaced by nitrous oxide. We conclude that the EEG effects of isoflurane and nitrous oxide are not additive and that nitrous oxide opposes the depression of isoflurane on the central nervous system.
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Randomized Controlled Trial Clinical Trial
Use of alfentanil with propofol for nasotracheal intubation without neuromuscular block.
We have investigated the effect of augmentation of propofol with alfentanil for nasotracheal intubation without neuromuscular block in 60 patients undergoing short elective maxillo-facial procedures as outpatients. After administration of glycopyrronium 5 micrograms kg-1 i.v., anaesthesia was induced with propofol 2.5 mg kg-1, or alfentanil 20 micrograms kg-1 and propofol 2.5 mg kg-1. ⋯ This difference was not significant. The cardiovascular response to intubation was attenuated in the alfentanil group.