British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Extradural analgesia with clonidine and fentanyl compared with 0.25% bupivacaine in the first stage of labour.
Conventional extradural analgesia during labour with 0.25-0.375% bupivacaine may induce motor weakness and subjective sensory deficit, reducing maternal satisfaction. Even in a regimen for ambulatory extradural analgesia (0.1% bupivacaine-fentanyl 2 micrograms ml-1), a potential for proprioreception impairment exists, which may impair safe ambulation. We have combined fentanyl with clonidine for extradural analgesia in labour, and compared its effects with 0.25% bupivacaine, in a randomized, double-blind study. ⋯ Patients in group 2 had a much higher incidence of motor weakness (P < 0.01), impaired perception of pinprick (P < 0.01) and impaired distal joint proprioception (P < 0.05) than group 1. We conclude that clonidine 120 micrograms-fentanyl 50 micrograms provided comparable extradural analgesic efficacy as 0.25% bupivacaine for the first stage of labour. Furthermore, unwanted neurological effects were significantly less.
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Randomized Controlled Trial Clinical Trial
Does pre-incisional thoracic extradural block combined with diclofenac reduce postoperative pain after abdominal hysterectomy?
In a double-blind, randomized study, we investigated 40 patients undergoing abdominal hysterectomy; patients received 0.5% plain bupivacaine 20 ml via a low thoracic extradural catheter and a diclofenac suppository (100 mg), either 30 min before incision (group 1) or 30 min after incision (group 2). All patients received a standard general anaesthetic and no opioid was used before or during operation. Postoperative analgesic requirements were measured using a patient-controlled analgesia (PCA) system. ⋯ There were no significant differences in VAS and VPS pain scores, although both scores were consistently higher in group 1. Patient satisfaction with the quality of analgesia, at 24 h, demonstrated no significant difference between the two groups. The combination of extradural block and diclofenac suppository given before operation did not appear to produce a clinically effective pre-emptive analgesic effect.
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Clinical Trial
Prospective evaluation of pharmacokinetic model-controlled infusion of propofol in adult patients.
We have tested prospectively the algorithm of White and Kenny for pharmacokinetic model-controlled infusion of propofol in 40 healthy Oriental adults. Anaesthesia consisted of a target-controlled infusion of propofol, 70% nitrous oxide and an infusion of alfentanil. For the first 20 patients studied, median performance error was -5%, median absolute performance error 19%, divergence -9% and wobble 6%. ⋯ There was a deterioration in performance of the revised model. Performance statistics for the original model in all 40 patients were: median performance error 2% (range -34 to 69%), median absolute performance error 21% (6-69%), divergence -17% (-92 to 49%) and wobble 7% (2-34%). The algorithm was found to perform adequately in our Oriental patient population.
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Randomized Controlled Trial Clinical Trial
Dose of propofol for laryngeal mask airway insertion in children: effect of premedication with midazolam.
We determined the dose-response curves and effective doses of propofol for insertion of the laryngeal mask airway (LMA) in 50 unpremedicated children and in 60 children premedicated with midazolam, aged 3-12 yr. One of several doses of propofol was administered i.v. over 15 s to groups of 10 children, and conditions for LMA insertion were assessed at 60 s. The dose-response curves were parallel (P = 0.94), but the curve for premedicated children was shifted significantly to the left of that for unpremedicated children and propofol requirements were reduced by one-third (P < 0.0001). The doses required for satisfactory LMA insertion in 50% and 90% of unpremedicated patients (ED50, ED90) (95% confidence interval) were 3.8 (3.4-4.2) mg kg-1 and 5.4 (4.7-6.8) mg kg-1, respectively; those for premedicated patients were 2.6 (2.2-2.8) mg kg-1 and 3.6 (3.2-4.3) mg kg-1, respectively.
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Randomized Controlled Trial Clinical Trial
Effect of ondansetron on nausea and vomiting after middle ear surgery during general anaesthesia.
The efficacy of ondansetron 4 mg and 8 mg was compared with placebo in the reduction of postoperative nausea, retching and vomiting (PONV) after middle ear surgery during general anaesthesia, in 75 patients, in a double-blind and randomized study. Both doses of ondansetron were predictors for a decrease in PONV and the number of doses of rescue antiemetic needed per patient (droperidol: from 0.72 in the placebo group to 0.32 in both the 4-mg and 8-mg groups). No reduction in PONV was observed in patients with a history of motion sickness, whereas in patients without a history of motion sickness, ondansetron reduced both the proportion of patients suffering from PONV from 53% to 20% (P < 0.05) and of those needing droperidol from 53% to 17% (P < 0.05).