British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial Controlled Clinical Trial
Manual compared with target-controlled infusion of propofol.
We studied 160 ASA I-II patients, anaesthetized with propofol by infusion, using either a manually controlled or target-controlled infusion system. Patients were anaesthetized by eight consultant anaesthetists who had little or no previous experience of the use of propofol by infusion. In addition to propofol, patients received temazepam premedication, a single dose of fentanyl and 67% nitrous oxide in oxygen. ⋯ With the exception of a clinically insignificant difference in heart rate, haemodynamic variables were similar in the two groups. Six of the eight anaesthetists found the target-controlled system easier to use, and seven would use the target-controlled system in preference to a manually controlled infusion. Anaesthetists without prior experience of propofol infusion anaesthesia quickly became familiar with both manual and target-controlled techniques, and expressed a clear preference for the target-controlled system.
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Comparative Study
Evaluation of the Pneupac Ventipac portable ventilator: comparison of performance in a mechanical lung and anaesthetized patients.
The performance of the Pneupac Ventipac portable gas-powered ventilator was evaluated in two stages. The accuracy of delivery of the ventilator was assessed using a mechanical lung model at different combinations of compliance and airway resistance to simulate normal and diseased lungs. The performance of the ventilator was then assessed in 20 anaesthetized patients. ⋯ Delivered tidal volume was between -19 and +12% of the present tidal volume in the group of anaesthetized patients using the ventilator in airmix mode. The ventilator was reliable and simple to use, and performance was within acceptable limits in the anaesthetized patients. However, we recommend that a means of verifying the adequacy of ventilation should always be used when transporting critically ill or anaesthetized patients with any portable ventilator, particularly when lung compliance or airway resistance may be abnormal.
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Randomized controlled studies were reviewed to assess the effectiveness and safety of antiemetics used for prophylaxis in paediatric strabismus surgery. Early and late vomiting (6 and 48 h after operation, respectively), and adverse effects were evaluated using the numbers-needed-to-treat method. In 27 reports with information on 2033 children, the mean incidence of early vomiting was 54% and of late vomiting 59%, without prophylaxis. ⋯ Metoclopramide 0.15 and 0.25 mg kg-1 was significantly better than control only for early vomiting. Propofol had a high incidence of oculocardiac reflex without conferring any significant antiemetic effect: it should not be used. The benefits of prophylactic antiemetic therapy are not proven.
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Randomized Controlled Trial Comparative Study Clinical Trial
Extradural, paravertebral and intercostal nerve blocks for post-thoracotomy pain.
Forty-five patients were allocated randomly to receive either a single intrathoracic block of four intercostal nerves, a continuous thoracic extradural infusion or a continuous paravertebral infusion of bupivacaine. Patients were allowed additional i.v. boluses of morphine via a PCA device. ⋯ There were no significant differences between the groups in pain, morphine consumption, respiratory function or adverse events. Moderate to severe respiratory depression was detected in 14 patients more than 2 h after operation.
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Comparative Study Clinical Trial Controlled Clinical Trial
Temporal summation during extradural anaesthesia.
We have investigated in 10 patients the effect of extradural anaesthesia on temporal summation by comparing pain thresholds to single and repeated (five impulses at 2 Hz) electrical stimuli and compared these tests with pinprick and cold stimulation. Bupivacaine 0.5% (20 ml) was injected at L2-3. After extradural anaesthesia the threshold to repeated stimuli was significantly lower than the threshold to single stimuli (P = 0.0007). ⋯ Pain to single electrical stimulation disappeared in six patients and pain to repeated electrical stimulation in one. Pain may be evoked by temporal summation of repeated electrical stimuli even when pinprick sensation, cold sensation and pain to single electrical stimuli are inhibited. Thus temporal summation should be taken into consideration when extradural analgesia is assessed.