British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Influence of dose and timing of administration of morphine on postoperative pain and analgesic requirements.
In a randomized, double-blind study, we have investigated the effect of dose and timing of administration of morphine on postoperative pain and analgesic requirements in 60 patients undergoing hysterectomy, with or without salpingo-oophorectomy. Patients were allocated randomly to one of three groups: during standardized general anaesthesia, group post received morphine 0.15 mg kg-1 i.v. at peritoneal closure after hysterectomy; group pre-low received morphine 0.15 mg kg-1 on induction of anaesthesia; and group pre-high received morphine 0.3 mg kg-1 on induction of anaesthesia. ⋯ Pain scores (at rest and on movement) were similar in the three groups. A large dose of morphine 0.3 mg kg-1 i.v. on induction of anaesthesia significantly reduced postoperative PCA morphine requirements compared with the smaller dose (0.15 mg kg-1) administered at induction or peritoneal closure, in patients undergoing hysterectomy, with or without salpingo-oophorectomy.
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Randomized Controlled Trial Clinical Trial
Delayed forced air warming prevents hypothermia during abdominal aortic surgery.
We have evaluated the efficacy of the delayed forced air warming during abdominal aortic surgery in 18 patients. Patients were allocated randomly to one of two groups: the control group (n = 9) received no intraoperative warming device; the Bair-Hugger group (n = 9) had active skin surface warming with an upper body cover. ⋯ In the control group, core temperature continued to decrease until the end of surgery, whereas in the Bair-Hugger group, the reduction in core temperature stopped after 1 h of warming, and then rewarming began. At the end of surgery, core temperature in the Bair-Hugger group was similar to core temperature before induction, and was higher than core temperature in the control group (P < 0.003).
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of ondansetron and prochlorperazine for the prevention of nausea and vomiting after adenotonsillectomy.
This study has compared the incidences of nausea, vomiting and headache after ondansetron 0.06 mg kg-1 i.v., prochlorperazine 0.2 mg kg-1 i.m. and prochlorperazine 0.1 mg kg-1 i.v. given during induction of general anaesthesia to 282 patients undergoing adenotonsillectomy. The cardiovascular effects of the drugs were similar. ⋯ Nausea and vomiting in the same patient was reduced from 29% to 2% by i.v. ondansetron (P < 0.0005) and to 3% by i.m. prochlorperazine (P < 0.0005), and appeared to be less severe in these groups. Headache was most frequent after i.v. ondansetron (35%: P < 0.05), but occurred with similar frequency after i.m. prochlorperazine (32%) and i.v. prochlorperazine (29%).
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Clinical Trial Controlled Clinical Trial
Radial artery tonometry: moderately accurate but unpredictable technique of continuous non-invasive arterial pressure measurement.
Radial artery tonometry provides continuous measurement of non-invasive arterial pressure (CNAP) by a sensor positioned above the radial artery. An inflatable upper arm cuff enables intermittent oscillometric calibration. CNAP was compared with invasive radial artery pressure recordings from the opposite wrist in 22 high-risk surgical patients with an inter-arm oscillometric mean arterial pressure difference < or = 10 mm Hg. ⋯ Individual accuracy of oscillometry was good or acceptable in all 22 patients. The trend in CNAP changes (difference between consecutive measurements) was sufficiently accurate during induction of anaesthesia, as only 47 (7.6%), 14 (2.3%) and 27 (4.4%) of 616 systolic, diastolic and mean CNAP values differed by more than 10 mm Hg of invasive pressure trends. We conclude that: intermittent oscillometry provides accurate arterial pressure monitoring; CNAP measurements offer a reliable trend indicator of pressure changes during induction of anaesthesia and may be considered an alternative to invasive pressure measurements, should arterial cannulation be difficult in an awake patient; and accuracy of absolute CNAP values is only moderate and unpredictable, thus radial artery tonometry should not replace invasive monitoring in high-risk patients during major surgical procedures.