British journal of anaesthesia
-
Randomized Controlled Trial Comparative Study Clinical Trial
Analgesia after day-case knee arthroscopy: double-blind study of intra-articular tenoxicam, intra-articular bupivacaine and placebo.
Arthroscopy of the knee is performed regularly on a day-case basis. Intra-articular bupivacaine produces transient analgesia and reports of analgesia using intra-articular morphine have produced conflicting results. Non-steroidal anti-inflammatory drugs given systemically can provide effective analgesia for this procedure. ⋯ Less analgesia was used in the first 24 h by patients in the tenoxicam group but the difference in time to first analgesia was not statistically significant. Side effects and disturbance by pain were similar in all groups. The use of intra-articular tenoxicam 20 mg at the end of arthroscopy reduced oral analgesic requirements during the first day after operation but did not alter patients' perception of pain.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Do anxiety or hypocapnia predispose to apnoea after induction of anaesthesia?
We have studied the incidence of apnoea after induction of anaesthesia in patients allocated randomly to receive a standardized dose of either propofol or etomidate. We measured anxiety before operation with a standard questionnaire and end-tidal carbon dioxide concentration from a mask during breathing 35% oxygen, before induction of anaesthesia. Respiration was measured by pneumotachograph and impedance pneumograph. ⋯ There was no relationship between apnoea and end-tidal carbon dioxide concentration in these patients. Anxiety did not relate to the incidence of apnoea with either induction agent. We conclude that apnoea after induction of anaesthesia with propofol is more likely if hypocapnia is present but we could not relate apnoea or hypocapnia to anxiety in the ward before operation.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Blood loss during first trimester termination of pregnancy: comparison of two anaesthetic techniques.
We have compared the effects of two anaesthetic techniques on blood loss during suction termination of pregnancy. Forty-eight ASA grade I-II patients were allocated randomly to one of two groups: group 1 received propofol induction followed by a standard propofol infusion; group 2 received propofol induction followed by maintenance with 1% isoflurane. Both groups received bolus doses of either propofol (group 1) or isoflurane (group 2) if anaesthesia was too light. ⋯ Estimation of blood loss was performed by atomic absorption spectrometry. Mean blood losses were 40.4 ml for the isoflurane group and 18.8 ml for the propofol group. This difference was statistically significant (P = 0.0011), although actual volumes of blood loss were small and not clinically significant.
-
Randomized Controlled Trial Clinical Trial
Low-dose mivacurium supplementation of prilocaine i.v. regional anaesthesia.
We have compared in two groups of five healthy volunteers, the motor effect of prilocaine i.v. regional anaesthesia of the forearm with and without addition of mivacurium 0.6 mg. Although addition of mivacurium might, theoretically, provide the benefit of increased neuromuscular block with rapid plasma cholinesterase degradation in the isolated limb, we observed prolonged forearm weakness in the mivacurium group using tests of grip strength (median recovery to 90% of control, 80 min (range 60 min to > 8 h) vs control median recovery to 90% of 16 (8-24) min) and bead transfer (median recovery to 90% of control 36 (24-48) min vs control median recovery to 90% of 12 (8-16) min). This weakness was considerably in excess of that predicted by rapid systemic degradation of mivacurium. The mivacurium group experienced symptoms of local anaesthetic toxicity which did not occur in the control group and which could not be replicated by administration of mivacurium alone.
-
We studied four electrophysiological variables (bispectral index (BIS), 95% spectral edge frequency (SEF), median frequency (MF) and auditory evoked potential index (AEP index) in 10 patients during emergence from anaesthesia. We compared correlation of the signals with gradually decreasing calculated blood propofol concentrations, and evaluated the signal differences between preinduction and emergence from anaesthesia. Values of BIS, MF and SEF correlated with calculated blood concentrations of propofol during emergence from anaesthesia. ⋯ Although AEP index values did not correlate with calculated blood concentrations of propofol during emergence from anaesthesia, values after eye opening and before anaesthesia were well distinguished from those during emergence from anaesthesia. BIS correlated best with calculated blood concentrations of propofol. AEP index appeared to distinguish the awake from asleep state.