British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparative potency of steroidal neuromuscular blocking drugs and isobolographic analysis of the interaction between rocuronium and other aminosteroids.
We have determined the relative potency of rocuronium, pancuronium, pipecuronium and vecuronium, and examined the nature of the interaction of rocuronium with the other three steroidal neuromuscular blocking drugs. We studied the dose-response relationships of each drug and their combination with rocuronium in 200 ASA I or II patients during propofol-fentanyl-nitrous oxide-oxygen anaesthesia. Neuromuscular block was recorded as the evoked thenar mechanomyographic response to single twitch stimulation of the ulnar nerve at 10-s intervals. ⋯ Corresponding doses producing 95% depression (ED95) of twitch height were, respectively, 322.1 (307.5-337.3), 58.1 (56.2-60.1), 48.7 (46.9-50.5) and 39.9 (38.4-41.4) micrograms kg-1. Based on the estimate of ED50, the relative potency was 1:4.5:5.4:6, respectively. The interaction between rocuronium and vecuronium, pipecuronium or pancuronium was found to be additive.
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Randomized Controlled Trial Clinical Trial
Enoximone and warming after hypothermic cardiopulmonary bypass.
In a randomized, controlled study of 24 patients undergoing myocardial revascularization, we found that enoximone 0.5 mg kg-1 i.v., followed by 5 micrograms kg-1 min-1, when rewarming after hypothermic cardiopulmonary bypass, prevented subsequent cooling of the periphery after transfer to the intensive care unit. Skin surface temperatures on the foot increased by mean 0.33 (SD 0.5) degree C h-1 in the enoximone group, but decreased by 0.43 (0.4) degree C h-1 in the control group until core temperature had increased to 37 degrees C (P < 0.001); only then did peripheral temperatures begin to increase in the control group. Enoximone did not merely redistribute heat from the core to the periphery. The capacity to transfer heat by the circulation rather than the ability to generate heat in the core appeared to limit body warming in the ICU after hypothermic cardiopulmonary bypass.
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Randomized Controlled Trial Clinical Trial
Effect of timing of ketorolac administration on patient-controlled opioid use.
In order to investigate the analgesic effect of timing of administration of ketorolac 10 mg i.v., we recorded patient-controlled use of diamorphine at 2, 4 and 12 h after abdominal hysterectomy. In a randomized, double-blind trial, 30 patients received ketorolac before skin incision and 28 after skin closure. A control group of 32 patients did not receive ketorolac. ⋯ The frequency of nausea and vomiting was similar in all groups Median blood loss in the group given ketorolac before operation exceeded that of the patients who did not receive ketorolac before operation (95% confidence interval 20-149 ml; P = 0.01). We conclude that the diamorphine-sparing effect of ketorolac attributable to timing of administration was small, conferred no clinical benefit and was accompanied by increased bleeding. No patient given ketorolac complained of pruritus.
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Randomized Controlled Trial Clinical Trial
Does the addition of morphine to brachial plexus block improve analgesia after shoulder surgery?
We have studied 40 patients undergoing elective shoulder surgery for chronically painful conditions. Patients were allocated randomly to two groups and received interscalene brachial plexus block with 0.5% bupivacaine and adrenaline 1/200,000 40 ml either alone or with the addition of morphine 5 mg. ⋯ The quality of the block, analgesic requirements and any complications or side effects were noted in the intraoperative period and during the 48 h after operation. No significant difference was seen in quality of analgesia or patient satisfaction between the two groups.
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Randomized Controlled Trial Clinical Trial
Haemodynamic effects of propofol infusion for sedation after coronary artery surgery.
We have compared the haemodynamic effects of a sedative dose of propofol with placebo (vehicle of propofol) in a randomized, double-blind study in 20 patients immediately after coronary artery bypass grafting (CABG). During a continuous infusion of a mixture of fentanyl and pancuronium, each patient was given in a crossover design, a loading dose of propofol 0.5 mg kg-1 and vehicle over 5 min followed by a continuous infusion of propofol 20 micrograms kg-1 min-1 and vehicle, respectively, for 55 min. ⋯ These data suggest that, during the recovery phase from CABG surgery, a short-term infusion of a sedative dose of propofol decreases systemic and pulmonary arterial pressure by decreasing systemic and pulmonary vascular resistance, respectively, and cardiac output. The decrease in cardiac output appeared to be caused mainly by a decrease in stroke volume.