British journal of anaesthesia
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Meta Analysis Comparative Study
Meta-analytic comparison of prophylactic antiemetic efficacy for postoperative nausea and vomiting: propofol anaesthesia vs omitting nitrous oxide vs total i.v. anaesthesia with propofol.
Data from two published and one new meta-analysis were reviewed to compare the antiemetic efficacy of three different anaesthetic regimens: (i) propofol anaesthesia compared with another anaesthetic (control); (ii) anaesthesia without nitrous oxide compared with the same anaesthetic with nitrous oxide (control); (iii) propofol anaesthesia without nitrous oxide (TIVA) compared with another anaesthetic with nitrous oxide (control). Efficacy (prevention of postoperative nausea and vomiting compared with control) was estimated using odds ratio and number-needed-to-treat methods, and compared within a range of 20-60% control event rates for early efficacy (0-6 h) and 40-80% for late efficacy (0-48 h). Propofol anaesthesia or omitting nitrous oxide had similar effects on vomiting, both early and late. ⋯ TIVA studies were documented poorly; appropriate comparison with other interventions were not possible. Efficacy of treatments should be compared within a setting-specific range of control event rates. There is insufficient evidence that TIVA with propofol is an anaesthetic technique with a low emetogenic potency.
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Randomized Controlled Trial Clinical Trial
Propofol attenuates formation of lipid peroxides in tourniquet-induced ischaemia-reperfusion injury.
We studied 20 adult ASA I patients undergoing elective peripheral surgery allocated randomly to one of two groups. In the propofol group (n = 9) anaesthesia was induced with propofol and fentanyl followed by continuous infusion of propofol. In the control group (n = 11), after induction of anaesthesia with thiopentone and fentanyl, anaesthesia was maintained with isoflurane. ⋯ In the propofol group this was significant only at 30 min (1.85 (0.03) vs 1.74 (0.04) mumol litre-1). TBARS concentrations of reperfused muscle tissue were significantly higher than pre-reperfusion concentrations in the control group (70.30(10.06) vs 52.13 (5.73) nmol/g wet tissue). We conclude that propofol attenuated ischaemia-reperfusion-induced lipid peroxidation in the therapeutic doses used in anaesthesia.
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In order to investigate haemodynamic response and catecholamine release during anaesthesia with xenon, we conducted a study on 28 pigs which were allocated randomly to one of four groups: total i.v. anaesthesia with pentobarbitone and buprenorphine, and xenon anaesthesia with inspiratory concentrations of 30%, 50% or 70%, respectively, supplemented with pentobarbitone. Haemodynamic variables were measured using arterial and Swan Ganz catheters. Depth of anaesthesia was monitored using spectral edge frequency analysis. ⋯ Adrenaline concentrations were reduced significantly in all groups. Xenon anaesthesia was associated with a high degree of cardiovascular stability. Significant reduction in adrenaline concentrations at inspiratory xenon concentrations of 30% and 50% can be explained by analgesic effects of xenon below its MAC value.