British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Ondansetron does not inhibit the analgesic effect of alfentanil.
5-Hydroxytryptamine (5-HT) causes antinociception via presynaptic 5-HT3 (5-HT subtype 3) receptors on primary afferent nociceptive neurones in the spinal cord dorsal horn. Therefore, ondansetron (a 5-HT3 receptor antagonist) may increase the perception of a noxious stimulus or decrease the effects of concurrently administered antinociceptive drugs. Using a randomized, double-blind, crossover study design, we have tested this hypothesis in eight healthy volunteers who, on three different days, received either ondansetron and placebo, ondansetron and alfentanil or placebo and alfentanil. ⋯ Ondansetron alone did not change the response to any of the experimental tests, but alfentanil and the combination ondansetron-alfentanil significantly changed the response compared with ondansetron alone. There was no difference between alfentanil alone and the combination ondansetron-alfentanil. We conclude that ondansetron does not change the response to pressure, heat, cold or electrical nociceptive stimuli or antagonize the analgesic effect of alfentanil.
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Randomized Controlled Trial Clinical Trial
Does training on an anaesthesia simulator lead to improvement in performance?
We have used the Leiden anaesthesia simulator, which makes use of a standard anaesthesia machine and monitors, and realistically simulates the anaesthesia work place. After obtaining informed consent, 28 anaesthetists and anaesthesia trainees in one hospital took part in the study. All participants were exposed to a pre-scripted simulated "control" scenario of anaphylactic shock (phase 1). ⋯ The participants in group B responded more quickly, treated better and deviated less from the accepted procedure during phase 3 than those in group A. The total performance of participants in group B during phase 3 was significantly better than those in group A. We conclude that training on an anaesthesia simulator does improve the performance of anaesthetists in dealing with emergencies during anaesthesia.
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Randomized Controlled Trial Clinical Trial
Intra-articular morphine after arthroscopic knee operation.
Reports on pain relief with intra-articular morphine after arthroscopic knee operation are conflicting. To assess the long-term antinociceptive effect of intraarticular morphine, we studied pain at rest, pain on standing and ability to walk for 7 days after intraarticular injection of bupivacaine 100 mg (group 1, n = 11), bupivacaine 100 mg and morphine 1 mg (group 2, n = 10) and bupivacaine 100 mg and morphine 3 mg (group 3, n = 10) at the end of operation. Pain and walking were assessed by visual analogue and walking scales, respectively. ⋯ The scores in group 2 were intermediate between those in groups 1 and 3. The walking scores in group 3 were significantly better than those in group 1 at 12 h. The amount of analgesics received in groups 2 and 3 was significantly less than that in group 1 until day 3 after operation.(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Clinical Trial
Effects of sub-hypnotic doses of propofol on the side effects of intrathecal morphine.
We have studied the effect of propofol on the side effects associated with intrathecal morphine in 40 patients undergoing major arthroplasty. Patients received spinal anaesthesia with plain 0.5% bupivacaine 20 mg mixed with preservative-free morphine 0.3 mg. Before injection of the local anaesthetic, the patients were allocated randomly to receive either a bolus dose of propofol 10 mg followed by an infusion of 30 mg/24 h or equal volumes of 10% Intralipid (control group). ⋯ The incidence of urinary retention was similar in both groups. There was no additional sedation attributable to propofol. In conclusion, sub-hypnotic doses of propofol protected significantly against itching and had a modest effect on PONV after intrathecal morphine.
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Randomized Controlled Trial Clinical Trial
Effects of hydrocortisone and adrenaline on natural killer cell activity.
We have studied the effects of hydrocortisone and adrenaline on natural killer (NK) cell activity and on the distribution of circulating lymphocyte subpopulations in 30 patients undergoing elective partial laminectomy under general anaesthesia. The patients were allocated to receive adrenaline (group 1, n = 11), hydrocortisone and adrenaline (group 2, n = 11) or neither hydrocortisone nor adrenaline (group 3, n = 8). Group 1 and group 2 patients received local adrenaline infiltration during operation to reduce bleeding. ⋯ In groups 1 and 3, the CD4/CD8 cell ratio did not change significantly during operation. However, compared with groups 1 and 3, group 2 showed a significantly reduced CD4/CD8 cell ratio during operation. Therefore, these results suggest that even in cases of such severe stress that the immune response was depressed by increased serum cortisol concentrations, adrenaline-induced NK cell activity enhancement was preserved.