British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial Retracted Publication
Influence of different volume therapy regimens on regulators of the circulation in the critically ill.
Various vasoactive substances are involved in the regulation of the macro- and microcirculation. We have investigated if these regulators change during long-term volume therapy with human albumin (HA) or hydroxyethylstarch solution (HES) in trauma and sepsis patients. To maintain pulmonary capillary wedge pressure (PCWP) at 10-15 mm Hg, either 20% HA (HA-trauma, n = 14; HA-sepsis, n = 14) or 10% low-molecular weight HES solution (HES-trauma, n = 14; HES-sepsis, n = 14) were infused for 5 days, otherwise patient management did not differ between the two groups (trauma/sepsis). ⋯ In both sepsis groups, vasopressors (vasopressin, endothelin-1, noradrenaline and adrenaline) were significantly increased above normal at baseline and decreased more markedly in HES than in HA patients. Concentrations of atrial natriuretic peptide increased only in the HA patients (from 159 (SD 31) to 215 (38) pg ml-1 on day 2). Plasma concentrations of 6-keto-prostaglandin F1 alpha decreased significantly only in the HES sepsis patients (from 112 (25) to 47 (15) pg ml-1).
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Randomized Controlled Trial Comparative Study Clinical Trial
Extradural clonidine combined with sufentanil and 0.0625% bupivacaine for analgesia in labour.
We have studied the use of clonidine combined with low doses of sufentanil and bupivacaine in 45 parturients requiring extradural analgesia for the first stage of labour, in a double-blind, randomized study. We gave 0.0625% bupivacaine 10 ml containing 1:200,000 adrenaline and sufentanil 10 micrograms (1 ml) to which was added 0.9% saline, or clonidine 100 or 150 micrograms (1 ml). We compared the quality (VAS scores) and duration of analgesia, motor block, maternal haemodynamic state (mean arterial pressure and heart rate) and fetal and maternal side effects. ⋯ Analgesia was associated with a reduction in mean arterial pressure with clonidine. However, these adverse side effects were of minor clinical importance regardless of the extradural clonidine dose, except for a high incidence of fetal heart tracing abnormalities when clonidine 150 micrograms was used. These effects associated with a limited effect on analgesia may curtail the widespread use of clonidine as an adjunct to extradural 0.0625% bupivacaine with sufentanil 10 micrograms during labour.
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Randomized Controlled Trial Comparative Study Clinical Trial
Neuromuscular blocking action of suxamethonium after antagonism of vecuronium by edrophonium, pyridostigmine or neostigmine.
The reported effects of edrophonium on a subsequent dose of suxamethonium are variable and the effects of pyridostigmine have not been evaluated extensively. We have studied this interaction in patients anaesthetized with propofol and sufentanil. After recovery from an initial bolus (1 mg kg-1) of suxamethonium, vecuronium was infused to produce 75% block. ⋯ Corresponding plasma cholinesterase activities (percentage of baseline) were: 91 (18), 87 (9), 21 (10) and 52 (26). When both treatment groups and individual patients were compared, the changes in duration of action did not correlate with changes in cholinesterase activity. These data suggest that other mechanisms in addition to cholinesterase inhibition may contribute to this drug interaction.
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Randomized Controlled Trial Comparative Study Clinical Trial
Evaluation of the usefulness of intrathecal bupivacaine infusion for analgesia after hip and knee arthroplasty.
Spinal anaesthesia in 47 ASA I-III patients was induced with 0.5% bupivacaine 2 ml via a 28-gauge spinal catheter (L3-4 interspace) and 0.5-ml increments were given if needed before or during hip or knee arthroplasty. Intrathecal 24-h infusions consisted of 0.5% bupivacaine 0.4 ml h-1 (2 mg h-1) (n = 12), 0.5% bupivacaine 0.2 ml h-1 (1 mg h-1) (n = 12) or saline (n = 11) (12 exclusions). Patients received oxycodone 0.1-0.14 mg kg-1 i.m. for rescue analgesia. ⋯ The incidence of nausea and vomiting was similar in all groups. Although an effective analgesic, intrathecal infusion of bupivacaine 2 mg h-1 cannot be recommended for routine pain relief because of the risk of increasing spinal block. Technical problems (19%) also reduced the overall efficacy of the continuous intrathecal analgesic regimen.