British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Effect of nebulized lignocaine on airway irritation and haemodynamic changes during induction of anaesthesia with desflurane.
This study was designed to assess the effect of nebulized lignocaine or saline given before induction on the quality of induction of anaesthesia with desflurane in unpremedicated, young, adult males. Of the first six patients, five developed laryngospasm, breath-holding, coughing and increased secretions. In four patients oxygen saturation decreased to 92% or less. ⋯ The incidence and severity of complications were not decreased by administration of nebulized lignocaine and were higher than those reported by other workers. We conclude that in unpremedicated, young, adult males, induction of anaesthesia with desflurane and nitrous oxide in oxygen was associated with a high incidence of respiratory irritant effects, tachycardia, hypertension and post-induction bradyarrhythmia. We also found that lignocaine, as used in this study, did not appear to obtund the cardiovascular and respiratory complications during inhalation induction using desflurane.
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Median nerve somatosensory evoked responses (MnSSER) were recorded in 15 healthy adult patients, ASA I-II, before and during orthopaedic surgery. After induction of anaesthesia with fentanyl 0.1-0.15 mg, etomidate 0.3 mg kg-1 and vecuronium 0.1 mg kg-1, anaesthesia was maintained with 0.6% isoflurane (end-tidal) and 66% nitrous oxide in oxygen. MnSSER were recorded after establishment of steady-state anaesthesia at baseline, during preparation (n = 11) and continuously after the start of surgery. ⋯ During intense surgical stimulation (e.g. periosteal stimulation) the peak-to-peak amplitude N20P25 increased significantly by more than 45% (P < 0.05), whereas latencies of all components did not change over time. These data indicate that MnSSER may be reliably monitored in the intraoperative period during steady-state isoflurane-nitrous oxide anaesthesia. In addition, concurrent changes in haemodynamic variables during nociceptive stimulation support the hypothesis that reversal of isoflurane-nitrous oxide-induced suppression of MnSSER may indicate increased nociceptive input when depth of anaesthesia is inadequate.
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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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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.