British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Interactions between mivacurium and atracurium.
We have studied the interaction between atracurium and mivacurium. The dose-response relationships of atracurium, mivacurium and their combination were studied in 96 ASA I or II patients during thiopentone-fentanyl-nitrous oxide-isoflurane (1.2% end-tidal) anaesthesia. Neuromuscular block was recorded as the evoked thenar mechanomyographic response to train-of-four stimulation of the ulnar nerve (2 Hz at 12-s intervals). ⋯ An additional 26 patients anaesthetized with thiopentone-fentanyl-nitrous oxide-isoflurane were allocated randomly to receive either atracurium 0.5 mg kg-1 (n = 13) or mivacurium 0.15 mg kg-1 (n = 13). Additional maintenance doses of mivacurium 0.1 mg kg-1 were administered to patients in both groups, whenever the first twitch recovered to 10% of control. The duration of the first maintenance dose of mivacurium to 10% recovery of the first twitch was greater (P < 0.0005) after atracurium (25 (21.8-28.5) min) than after mivacurium (14.2 (11.9-16.6) min).(ABSTRACT TRUNCATED AT 250 WORDS)
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Preoperative fasting was introduced to reduce the risk and severity of aspiration pneumonitis. Adequate time (6h) must still be allowed before operation for solid foods to be emptied from the stomach. However, the overwhelming weight of evidence supports the practice of reducing the duration of the preoperative fluid fast for elective paediatric surgical patients [3, 15]. ⋯ Potential benefits of reduced thirst, better perioperative experience, improved compliance and reduced hypoglycaemia may be seen. Patients at risk of GOR and aspiration pneumonitis, including those presenting for emergency surgery, must receive special consideration. As aspiration pneumonitis is so rare, careful reporting of complications potentially related to a reduced fasting period is necessary.
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Randomized Controlled Trial Comparative Study Clinical Trial
Pre-emptive analgesia: comparison of preoperative with postoperative caudal block on postoperative pain in children.
We have compared in 25 children the effect of preoperative with postoperative caudal block on pain after circumcision in a double-blind, randomized study. After induction of anaesthesia, patients were allocated randomly to receive a caudal block either before (n = 14) or immediately after (n = 11) surgery. Postoperative pain was rated on a paediatric pain scale. ⋯ Using the Mann-Whitney U test (significance < or = 0.05) there was no significant difference in cumulative postoperative analgesic requirements within the first 48 h and in times to first analgesic administration between the groups. Cumulative pain score, assessed every 30 min for the first 8 h after operation, was significantly lower for those patients who received caudal anaesthesia after operation. Thus we could not demonstrate any advantage in performing caudal block before compared with after surgery.