British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of i.v. and s.c. diamorphine infusions for the treatment of acute pain in children.
We have compared the i.v. and s.c. routes of administration for diamorphine infusions in children undergoing abdominal surgery. Subjects received general anaesthesia with extradural block and diamorphine up to 20 micrograms kg-1 h-1 after operation. There were no differences between the groups in diamorphine consumption, pain scores or incidence of side effects. The s.c. route appeared to be as effective and safe as the i.v. route for administration of diamorphine infusions in children undergoing elective surgery.
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Comparative Study Clinical Trial Controlled Clinical Trial
Cognitive failures after general anaesthesia for day-case surgery.
Patients are normally thought to have recovered from general anaesthesia within a few hours after day-case surgery. Previous recovery studies using objective psychometric tests showed a return to baseline values within this period. Nevertheless, patients are advised about what activities they should not undertake in the subsequent 24 h because it is feared that the residual anaesthetic effects may impair their ability. ⋯ Using the cognitive failures questionnaire, a standard measure of performance of everyday tasks, 54 patients were asked to report their own performance after general anaesthesia for the 3 days after discharge from hospital: 30 local anaesthetic patients were studied for comparison. The general anaesthesia group reported a highly significant greater incidence of cognitive failures after anaesthesia compared with the local anaesthesia group. This suggests that the residual effects of anaesthesia persist beyond 24 h.
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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 Comparative Study Clinical Trial
Comparison of nicardipine, diltiazem and verapamil for controlling the cardiovascular responses to tracheal intubation.
We have compared the efficacy of three calcium channel blockers, nicardipine, diltiazem and verapamil, in attenuating the cardiovascular responses to laryngoscopy and intubation in 60 normotensive patients (ASA I) undergoing rapid sequence induction of anaesthesia with thiopentone and fentanyl. We also examined whether or not these blockers inhibited catecholamine release induced by intubation. The patients were allocated to one of four groups (n = 15 for each): saline (control), nicardipine 30 micrograms kg-1, diltiazem 0.2 mg kg-1 or verapamil 0.1 mg kg-1. ⋯ The greatest effect was elicited by verapamil, which attenuated the increase in HR, although nicardipine seemed to enhance tachycardia. All three drugs failed to suppress the increase in plasma catecholamine concentrations in response to tracheal intubation. These findings suggest that bolus injection of verapamil 0.1 mg kg-1 was a more effective method of controlling hypertension and tachycardia associated with intubation than diltiazem 0.2 mg kg-1 or nicardipine 30 micrograms kg-1, and that these prophylactic effects were not caused by inhibition of the catecholamine response.