British journal of anaesthesia
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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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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
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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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.
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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.