British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial Controlled Clinical Trial
Comparison of i.m. and local infiltration of ketorolac with and without local anaesthetic.
We have studied postoperative analgesia in 32 patients undergoing outpatient repair of inguinal hernia. All patients received a standardized general anaesthetic of thiopentone followed by halothane or isoflurane in 70% nitrous oxide and oxygen delivered by face mask or laryngeal mask with spontaneous ventilation. No patient received premedication, opioids or neuromuscular blockers. ⋯ There were no significant differences in pain scores at any time between the three study groups. Wound infiltration with ketorolac 30 mg in saline, 0.25% bupivacaine or ketorolac 30 mg with 0.25% bupivacaine provided equivalent analgesia. Wound infiltration with ketorolac 30 mg in saline provided analgesia superior to that of ketorolac 60 mg i.m.
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To ascertain the effects of chronic renal failure on the pharmacokinetics of 1R-cis 1'R-cis atracurium besylate (a stereoisomer, designated 51W89), we gave a bolus dose of 0.1 mg kg-1 (2 x ED95) to 17 patients with end-stage renal failure and to 15 patients with normal renal function undergoing elective surgery. All patients received thiopentone, fentanyl and midazolam i.v. and 70% nitrous oxide in oxygen. Blood samples were obtained over 8 h and plasma analysed for 51W89 and laudanosine concentration, using high pressure liquid chromatography. ⋯ The typical value of T1/2 beta was 4.2 min longer in renal failure than in the healthy patients (34.2 vs 30.0 min, P < 0.005). In the healthy patients, clearance of 51W89 was greater in males, but it decreased with increasing age by approximately 1.5 ml min-1 yr-1. Mean plasma laudanosine concentrations were significantly higher in the renal failure group; nevertheless, they were approximately one-tenth of those reported after atracurium.
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Forty consecutive patients who could not be weaned from mechanical ventilation in the intensive care unit (ICU) entered a multidisciplinary progressive care programme (PCP). The mean number of hours per day of ventilatory support was 19.9 at the time of transfer but only 6.7 at discharge. ⋯ Seventy-six percent were alive 1 yr after discharge and 80% of patients were discharged directly from the PCP to their homes. Mental and emotional scores in a quality of life questionnaire (SF 36) were normal, but physical function remained limited.
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To investigate the effects of propofol on small vessels, we have measured changes in diameter and blood flow in microcirculatory venules and arterioles. Studies were carried out in the dorsal skinfold chamber of hamsters by intravital fluorescence microscopy. A bolus injection of propofol 25 mg kg-1 dilated small and collecting venules by a mean value of 18% and arterioles by 13%. ⋯ Therefore, propofol and Intralipid induced venodilatation and enhanced blood flow after bolus administration. After 4 h, despite dilatation in both groups, only post-capillary venules showed enhanced blood flow. These observations suggest redistribution of blood flow after prolonged administration of propofol.