British journal of anaesthesia
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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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Randomized Controlled Trial Clinical Trial
Use of i.v. insulin in well-controlled non-insulin-dependent diabetics undergoing major surgery.
We conducted a randomized, prospective study to assess the effect of i.v. insulin on blood glucose control, development of ketone bodies and hormonal changes in 60 well-controlled, non-insulin-dependent diabetics (NIDDM) undergoing major surgery. In group A, patients were given only 0.9% saline; in group B, patients were given insulin as a continuous i.v. infusion (1.25 u. h-1); in group C, patients were given insulin 10 u. i.v. boluses every 2 h. Patients in all three groups were given insulin 5 u. when their intraoperative blood glucose concentration increased to greater than 11.1 mmol litre-1. ⋯ Plasma C-peptide concentrations decreased significantly in groups B and C, especially in patients given bolus injections of insulin. Plasma growth hormone concentrations also increased significantly in group B and C patients. This study indicated that the "no insulin--no glucose" regimen was a simple, effective way to control blood glucose in well-controlled NIDDM patients, provided blood glucose was measured frequently and insulin used appropriately.
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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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We have studied the effect of FIO2 of a nitrous oxide-oxygen mixture on the rate of gas uptake from an unventilated lung. Nine anaesthetized dogs were studied, each breathing four nitrous oxide-oxygen mixtures (FIO2 0.3, 0.5, 0.75 and 1.0) in random order. A double-lumen endobronchial tube separated lung ventilation. ⋯ Then the right lung was connected to a spirometer containing the same gas, and gas uptake measured. In every dog, gas uptake was faster with an FIO2 of 0.5 or 0.75 than with an FIO2 of 1.0. When breathing a nitrous oxide-oxygen mixture with FIO2 > 0.3, the rate of gas uptake from the unventilated lung was faster than with 100% oxygen.