British journal of anaesthesia
-
Randomized Controlled Trial Clinical Trial
Thenar muscle blood flow and neuromuscular effects of vecuronium in patients receiving balanced or isoflurane anaesthesia.
We have tested the hypothesis that isoflurane potentiates non-depolarizing neuromuscular block via an increase in muscle blood flow. Anaesthesia was induced with thiopentone 4-5 mg kg-1 in 30 adult male patients of ASA physical status I or II and was maintained with 70% nitrous oxide in oxygen supplemented with either a bolus dose of fentanyl 4 micrograms kg-1 followed by an infusion of 1 microgram kg-1 h-1 (balanced anaesthesia group, n = 15) or 1.1% end-tidal isoflurane (isoflurane group, n = 15). Vecuronium 0.1 mg kg-1 was given for neuromuscular block. ⋯ Thenar muscle blood flow was comparable in the two groups throughout the study. We conclude that isoflurane prolonged vecuronium-induced neuromuscular block. This prolongation was not related primarily to increase in muscle blood flow.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of the analgesic and emetic properties of ketorolac and morphine for paediatric outpatient strabismus surgery.
In a prospective, double-blind, randomized study, we have compared i.v. ketorolac and morphine in paediatric outpatients undergoing strabismus surgery. Forty-two ASA I or II children, aged 2-12 yr, were allocated randomly to receive either ketorolac 0.75 mg kg-1 i.v. or morphine 0.1 mg kg-1 i.v. and metoclopramide 0.15 mg kg-1. Anaesthesia was induced with propofol and maintained with propofol and nitrous oxide. ⋯ There was no difference in pain behaviour scores or recovery times. The incidence of nausea and vomiting during the first 24 h was 19% in the ketorolac group and 71% in the morphine group (P < 0.001). We concluded that ketorolac was an effective analgesic for this type of surgery and that it was associated with less postoperative emesis than morphine and metoclopramide.
-
Randomized Controlled Trial Clinical Trial
Effect of antagonizing residual neuromuscular block by neostigmine and atropine on postoperative vomiting.
Eighty patients undergoing outpatient surgery under general anaesthesia were allocated randomly to two groups: in group A residual neuromuscular block was antagonized with a mixture of neostigmine 1.5 mg and atropine 0.5 mg; in group B spontaneous recovery was allowed. The patients were assessed after operation in hospital and 24 h after discharge. ⋯ There was no significant difference in frequency of nausea or vomiting between the two groups. The incidence of postoperative nausea was 14 in group A and 18 in group B and the number of patients with postoperative vomiting was 10 in group A and 15 in group B.
-
Randomized Controlled Trial Comparative Study Clinical Trial
The modifying influence of anaesthesia on postoperative protein catabolism.
We studied two groups of six patients scheduled for gastrointestinal surgery; they were allocated randomly to receive high- or low-dose fentanyl anaesthesia. The confounding effect of protein balance, before the trauma of surgery, on postoperative nitrogen excretion was controlled by standardized protein intake before operation, supplemented by adequate calories. ⋯ The high-dose group had significantly lower postoperative excretion of ammonia and slightly lower excretion of urea and 3-methylhistidine. Low-stress anaesthesia may thus diminish postoperative catabolism, which could be important in frail patients by reducing mortality, ICU resources, or both.
-
Randomized Controlled Trial Clinical Trial
Effect of ilioinguinal and iliohypogastric nerve block and wound infiltration with 0.5% bupivacaine on postoperative pain after hernia repair.
We have compared, in 40 adult males, the effect on pain in the first 24 h after herniorrhaphy of preincisional ilioinguinal and iliohypogastric nerve block and wound infiltration with 0.5% bupivacaine or saline. After operation, patients received morphine i.v. via a patient-controlled analgesia machine and visual analogue pain scores (VAS) at rest and on movement were recorded. The bupivacaine group consumed less morphine in the first 6 h after operation. ⋯ There was no significant difference in VAS scores at rest but there was a significantly higher pain score with movement in the saline group. We have shown that the combination of nerve block and wound infiltration reduces consumption of morphine in the first 24 h after herniorrhaphy. We have failed to show any effect of 0.5% bupivacaine beyond the first 6 h after operation.