British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Topical glucocorticoid has no antinociceptive or anti-inflammatory effect in thermal injury.
We have studied the antinociceptive and anti-inflammatory effects of topical glucocorticoids in human thermal injury. The right and left legs of 12 healthy volunteers were allocated randomly to be treated with either 0.05% clobetasol propionate cream or placebo in a double-blind trial. Thermal injuries were induced with a thermode, which was heated to 49 degrees C for 5 min under standardized pressure. ⋯ Heat pain detection thresholds (HPDT), heat pain tolerance (HPT), mechanical pain detection thresholds (MPDT) and the intensity of burn-induced erythema (erythema index, EI) were assessed inside the thermal injury and areas of hyperalgesia to pinprick outside the injury were determined before and regularly for 72 h after the burn injury. Burn injury caused a decrease in HPDT, HPT and MPDT, an increase in EI and development of mechanical, secondary hyperalgesia. Clobetasol propionate had no effect on any of the nociceptive or inflammatory variables studied.
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Randomized Controlled Trial Clinical Trial
Influence of droperidol on nausea and vomiting during patient-controlled analgesia.
We have studied the addition of droperidol to morphine during patient-controlled analgesia (PCA) in 57 patients using PCA after abdominal hysterectomy. Patients in group 1 (control group) received placebo at induction of anaesthesia and a PCA containing morphine; those in group 2 received droperidol 1.25 mg and a PCA containing morphine and those in group 3 droperidol and a PCA containing droperidol 0.05 mg mg-1 of morphine. ⋯ We did not observe side effects attributable to droperidol. We conclude that droperidol added to morphine in PCA reduces nausea and antiemetic requirements after abdominal hysterectomy.
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Randomized Controlled Trial Comparative Study Clinical Trial
Risk of aspiration with the laryngeal mask.
In order to assess if the use of the laryngeal mask airway is associated with an increased risk of gastric regurgitation during mechanical ventilation, we studied 50 patients allocated randomly to undergo anaesthesia with either artificial ventilation with isoflurane and nitrous oxide in oxygen and atracurium (group A) or spontaneous ventilation with isoflurane and nitrous oxide in oxygen (group B). In both groups a laryngeal mask airway was used. ⋯ In one patient in each group, there was staining of the oropharynx with blue dye at the end of surgery. In the patient in group A, dye was present in the trachea and bronchi.
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We have described the design and design considerations of the desflurane Tec 6 "vaporizer" and have tested its performance characteristics. The vaporizer differs from previous vaporizers designed for anaesthesia in that electromechanical rather than mechanical controls accommodate the different physical characteristics of desflurane. This design, while offering perhaps an increased risk of failure (owing to sophisticated electronic components and circuitry), on the other hand offers the decreased likelihood of accidental delivery of very large concentrations of liquid anaesthetic resulting from tilting or overfilling and alarms and warnings not previously incorporated into the design of anaesthetic vaporizers. The output characteristics of the vaporizer are as expected, based on the design: desflurane concentration output in oxygen has accuracy (+/- 15%) which is similar to that of the mechanical vaporizers; output decreases when nitrous oxide is added owing to the lower viscosity, but remains within 20% of the dial setting or 0.5% absolute.
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Comparative Study
The effects of sevoflurane are similar to those of isoflurane on the neuromuscular block produced by vecuronium.
We have examined the interactions of 1 MAC of isoflurane and sevoflurane (and 66% nitrous oxide in oxygen) with vecuronium, using the EMG response of the abductor digiti minimi to train-of-four (TOF) stimulation of the ulnar nerve. We constructed dose-response curves for vecuronium in 54 patients. ⋯ The rate of recovery of T4:T1 was significantly greater when both anaesthetics were discontinued. However, this rate was similar for both anaesthetics, suggesting that the mechanism of action of the two anaesthetics is similar.