British journal of anaesthesia
-
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.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Intraoperative glycaemic control in non-insulin-dependent and insulin-dependent diabetes.
We have compared intraoperative glycaemic control, insulin requirements and metabolic and endocrine variables in 40 non-insulin-dependent diabetic patients (NIDDM) and 40 insulin-dependent diabetic patients (IDDM) undergoing general anaesthesia for elective procedures. Two i.v. insulin regimens were used: continuous i.v. infusion (group A: 1.25 u.h-1) and repeated i.v. boluses (10 u./2 h). Blood concentrations of glucose were measured every 15 min from just before induction of anaesthesia until 2 h after surgery. ⋯ We conclude that mean glycaemic control, insulin requirements and development of ketone bodies in NIDDM and IDDM patients did not differ during the operative period, regardless of the insulin regimen used. Therefore, during the operative period, it is not necessary to modify the insulin regimen according to the type of diabetes. The consequences of increased plasma GH concentrations on glycaemic control in IDDM patients after operation are unknown.
-
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)
-
We have studied the haemodynamic effects of subarachnoid block in elderly patients. Thirty patients were undergoing elective transurethral surgery and 18 non-elective orthopaedic surgery, predominantly fractured neck of femur. Systolic arterial pressure (SAP) was measured by automated oscillotonometry, central venous pressure (CVP) by manometer and cardiac index (CI), stroke index (SI) and heart rate (HR) by transthoracic electrical bioimpedance. ⋯ CVP, SI and HR were all restored to baseline values, however, SVRI was decreased further (P < 0.05). Fourteen patients required additional treatment with metaraminol which restored SVRI to baseline values. Patients with systolic hypertension were more likely to require treatment with metaraminol (P = 0.04).
-
Randomized Controlled Trial Comparative Study Clinical Trial
Effects of midazolam and diazepam as premedication on heart rate variability in surgical patients.
We have examined the effects of midazolam 0.06 mg kg-1 i.m. and diazepam 0.2 mg kg-1 orally as premedication on the spectral components of heart rate (HR) variability in 24 elderly patients aged 65-87 yr and 24 young patients aged 18-35 yr undergoing elective surgery. The low-frequency/high-frequency (LF/HF) ratio of HR variability increased after arrival in the operating room in elderly patients who received no premedication, but not in young patients. ⋯ However, diazepam increased the low-frequency component and the total power of HR variability in both young and elderly patients. We conclude that cardiac sympathetic nerve activity increased after arrival in the operating room in the elderly, that midazolam or diazepam reduced this increase and that diazepam caused an increase in the total power of HR variability that has not been observed for other agents.