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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Comparative Study
Duration of spinal anaesthesia is determined by the partition coefficient of local anaesthetic.
We have compared the duration of motor block produced by four local anaesthetics administered into a chronically implanted subarachnoid catheter in rabbits. Each group (n = 6) received four different doses of amethocaine, bupivacaine, lignocaine or procaine, and the duration of the resulting motor block was assessed. Dose-response curves were plotted for each drug. ⋯ An inverse linear correlation (r = 0.995; P < 0.01) was observed between log D60 min and the log of the partition coefficient of the local anaesthetics. No correlation was found between the effect and degree of protein binding, pKa or molecular weight. These results suggest that, in spinal anaesthesia, the partition coefficient could be used as a predictor of the duration of anaesthetic action.
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Paravertebral catheters were placed bilaterally through a Tuohy needle under direct video control in a patient undergoing video-assisted thoracoscopic (VAT) surgery for recurrent, bilateral pneumothoraces. Postoperative analgesia was produced by infusing bupivacaine through the catheters. This provided good analgesia. VAT placement of paravertebral catheters is easily accomplished and may be a part of the surgical procedure.
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We describe the successful use of the short-acting, non-depolarizing neuromuscular blocking agent, mivacurium, in a patient with myasthenia gravis taking pyridostigmine 120 mg four times daily. Increased sensitivity to mivacurium was demonstrated using train-of-four monitoring. ⋯ Residual block was antagonized without difficulty using neostigmine 2.5 mg. We discuss the relationship between plasma cholinesterase, acetylcholinesterase and anticholinesterase drugs.