British journal of anaesthesia
-
Randomized Controlled Trial Clinical Trial
Antagonism of mivacurium block with edrophonium from various degrees of spontaneous recovery.
Seventy adult patients received mivacurium 0.15 mg kg-1 during anaesthesia with thiopentone, nitrous oxide and 0.5% halothane. Neuromuscular block was monitored using mechanomyography and train-of-four stimulation. ⋯ The mean time taken from administration of mivacurium to attaining a TOF ratio of 0.7 was between 19.3 and 24.9 min in the groups given edrophonium, regardless of the time of administration, compared with 26.7 min in the spontaneous recovery group. The differences, however, were not significant among the groups showing little advantage in antagonizing mivacurium block.
-
Randomized Controlled Trial Clinical Trial
Effects of propofol and thiopentone, and benzodiazepine premedication on heart rate variability measured by spectral analysis.
We studied the effects of temazepam premedication and induction of anaesthesia with thiopentone or propofol on the heart rate power spectrum in 47 patients undergoing elective minor surgery. Eighteen patients received temazepam 20 mg orally as premedication. ⋯ Patients who had received temazepam premedication had significantly greater low frequency, high frequency and total power than those who were not premedicated. There was no significant difference between premedicated and unpremedicated patients in the ratio of low to ventilatory frequency power.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Extradural fentanyl for postoperative analgesia: predominant spinal or systemic action?
This randomized, double-blind study of 40 patients was designed to determine if the predominant analgesic effect of extradural fentanyl is mediated by a direct spinal action or an indirect systemic one. After Caesarean section, postoperative analgesia was provided for 24 h by patient-controlled extradural analgesia (PCEA group) or by patient-controlled i.v. analgesia (PCIVA group). Both groups received a bolus dose of fentanyl 20 micrograms with a 10-min lockout interval. ⋯ Mean visual analogue pain scores (0-100 mm) at 8 and 12 h were lower for PCEA (23 (sd 13) mm at rest, 31 (23) mm on coughing) than for PCIVA (50 (25) mm at rest, 67 (24) mm on coughing) (P < 0.0005). The mean dose of fentanyl self-administered between 4 and 8 h was lower in the PCEA group (38 (sd 30) micrograms h-1) compared with the PCIVA group (59 (27) micrograms h-1) (P < 0.05). Our results support the hypothesis that the predominant analgesic effect of extradural administration of fentanyl is mediated by a direct spinal action rather than an indirect action from systemic absorption.
-
The endothelium appears to play an important role in the regulation of intravascular coagulation. Thrombomodulin is one of the anticoagulant substances that is expressed by endothelial cells. The influence of age and illness on the thrombomodulin-protein C system was studied prospectively in 80 cardiac surgery patients. ⋯ After bypass and after operation, thrombomodulin increased most in patients > 70 yr (from 40 (8) to 78 (10) ng ml-1) and in those patients who underwent complex cardiac operations (from 52 (8) to 79 (10 ng ml-1) (P < 0.05). Changes in protein C and protein S concentrations were similar in all groups. On the first day after operation only, protein C concentrations were reduced in patients > 70 yr and in patients who underwent complex cardiac surgery.(ABSTRACT TRUNCATED AT 250 WORDS)