British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Use of modified fluid gelatin and hydroxyethyl starch for colloidal volume replacement in major orthopaedic surgery.
We have compared 6% hydroxyethyl starch (HES 200/0.5) with 3% modified fluid gelatin (MFG) for volume replacement in major orthopaedic surgery and studied the effects on haemodynamic state, colloid osmotic pressure, blood clotting and plasma homeostasis. Using a controlled, randomized, single-blind clinical design, we studied 46 consecutive patients undergoing major elective orthopaedic hip surgery. The two groups were comparable in age, body weight and duration of surgery. ⋯ Laboratory variables were not clinically different. We conclude that both colloidal solutions were comparable in volume efficacy and effects on plasma oncotic pressure, clotting and plasma homeostasis. In the small number of patients studied, 6% HES 200/0.5 was found to be safe when administered in amounts corresponding to the currently accepted maximum daily dose in Germany and France of 33 ml/kg body weight and 2.0 g/kg body weight, respectively.
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Randomized Controlled Trial Clinical Trial
Low-dose rocuronium improves conditions for tracheal intubation after induction of anaesthesia with propofol and alfentanil.
We studied 60 adult patients to assess if low doses of rocuronium improved conditions for tracheal intubation during induction of anaesthesia with propofol 2.5 mg kg-1 and alfentanil 10 micrograms kg-1. In a double-blind, randomized design, patients were allocated to one of three groups: group P = saline; group R1 = rocuronium 0.1 mg kg-1; and group R3 = rocuronium 0.3 mg kg-1. Intubation conditions were judged as optimal, suboptimal or failure, based on the scoring of ease of jaw opening and laryngoscopy, position of the vocal cords and degree of straining after tracheal intubation. ⋯ The addition of low doses of rocuronium significantly improved intubation conditions (P < < 0.001). Ventilation was controlled during surgery, and in no patient was any problem encountered with antagonism of neuromuscular block with neostigmine. Injection of rocuronium 0.3 mg kg-1 (ED95) with propofol and alfentanil provided a high proportion of optimal intubation conditions.
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Randomized Controlled Trial Clinical Trial
IV perioperative ketoprofen in small children during adenoidectomy.
We have investigated the analgesic and opioid sparing effect of perioperative i.v. ketoprofen in a randomized, double-blind, placebo-controlled, parallel group study in 164 children, aged 1-7 yr, after adenoidectomy. A standard anaesthetic method was used and all children received fentanyl 1 microgram kg-1 i.v. during induction. Children in the ketoprofen group received ketoprofen 1 mg kg-1 i.v. after induction of anaesthesia followed by an infusion of ketoprofen 1 mg kg-1 over 2 h. ⋯ Worst pain observed in the postanaesthesia care unit was also lower in the ketoprofen group both at rest (P = 0.028) and during swallowing (P = 0.001). There were no difference in the number of adverse reactions between the groups. No serious adverse reactions occurred.
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Randomized Controlled Trial Clinical Trial
Effect of clonidine on gastric emptying of liquids.
We have investigated the effects of clonidine on gastric emptying of liquids in 30 patients. In a double-blind, randomized design, clonidine 150 micrograms, morphine 10 mg or saline in 1 ml was given i.m. One hour later, the patient drank a paracetamol solution (1.5 g in 50 ml water). ⋯ Arterial pressure was significantly lower in the clonidine group compared with the saline group. Both clonidine and morphine appeared to cause mild sedation. We conclude that clonidine 150 micrograms i.m. does not delay gastric emptying of liquids in a similar manner to morphine.
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Randomized Controlled Trial Clinical Trial
Extradural morphine gives better pain relief than patient-controlled i.v. morphine after hysterectomy.
We examined if patient-controlled analgesia (PCA) with i.v. morphine provided comparable postoperative analgesia after hysterectomy as extradural morphine, without increasing the incidence of side effects. The study (n = 40) was randomized and double-blind. An extradural catheter was inserted before surgery and anaesthesia was standardized. ⋯ Plasma concentrations of morphine varied 8-10-fold in both groups. In the i.v. group itching, tiredness, blurred vision and vertigo correlated with cumulative consumption of i.v. morphine whereas in the extradural group this correlation existed only for tiredness. Both groups showed reduced ability to perform tests of cognitive function, indicating a central effect of both i.v. and extradural morphine, despite markedly lower plasma morphine concentrations in the extradural group.