British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Prevention of postoperative nausea and vomiting in female patients during menstruation: comparison of droperidol, metoclopramide and granisetron.
The incidence of postoperative nausea and vomiting (PONV) is high in women during menstruation. We have compared the efficacy of droperidol, metoclopramide and granisetron in the prevention of PONV in female patients during menstruation undergoing major gynaecological surgery. In a randomized, double-blind study, 120 patients received droperidol 25 micrograms kg-1, metoclopramide 0.2 mg kg-1 or granisetron 40 micrograms kg-1 (n = 40 in each group) i.v. immediately before induction of anaesthesia. ⋯ There was a complete response, defined as no PONV and no administration of rescue medication, during the 24-h observation period in 45% of patients in the droperidol group, 38% in the metoclopramide group and 70% in the granisetron group (P = 0.021 vs droperidol, P = 0.003 vs metoclopramide). There was no difference in the incidence of adverse events between groups. We conclude that the prophylactic antiemetic efficacy of granisetron was superior to that of droperidol or metoclopramide for prevention of PONV in women during menstruation.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of intubating conditions after rocuronium or vecuronium when the timing of intubation is judged by clinical criteria.
The onset of action and intubating conditions after rocuronium 0.6 mg kg-1 or vecuronium 0.1 mg kg-1 were compared in a randomized, double-blind study when the timing of tracheal intubation was determined by clinical judgment alone. Times to laryngoscopy and completion of intubation were mean 89 (SD 20) s and 119 (28) s, respectively, in the rocuronium group compared with 110 (26) s and 142 (32) s in the vecuronium group (P < 0.05 in both cases). Recuronium also resulted in significantly better intubating conditions compared with vecuronium but with no significant reduction in the haemodynamic response to intubation. We found that onset of satisfactory intubating conditions after rocuronium was detected clinically, although even earlier intubation should be possible by careful timing or by neuromuscular monitoring.
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Randomized Controlled Trial Clinical Trial
Effects of preinduction and intraoperative warming during major laparotomy.
We have investigated the influence of active warming before and during operation on blood loss, transfusion requirements, duration of stay in the post-anaesthesia care unit (PACU) and perioperative costs in 40 patients undergoing major abdominal surgery. Patients were allocated randomly to one of two groups: in the study group (n = 20), patients were actively warmed using forced air for 30 min before induction of general anaesthesia and during anaesthesia. ⋯ At the end of surgery the change in core temperature was significantly less in the group of actively warmed patients (0.5 (SD 0.8) degree C vs 1.5 (0.8) degree C; P < or = 0.01). Blood loss and transfusion requirements were less in the actively warmed patients, who had a shorter duration of stay in the PACU (94 (SD 42) min vs 217 (169) min; P < or = 0.01) and a 24% reduction in total anaesthetic costs.
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Randomized Controlled Trial Comparative Study Clinical Trial
Desflurane maintains intraocular pressure at an equivalent level to isoflurane and propofol during unstressed non-ophthalmic surgery.
We have investigated the effects of desflurane compared with isoflurane and propofol on intraocular pressure (IOP) in 48 ASA I-II patients undergoing elective non-ophthalmic surgery. Anaesthesia was induced with thiopental 3-5 mg kg-1, fentanyl 2-4 micrograms kg-1 and vecuronium 0.1 mg kg-1. Patients were allocated randomly to receive propofol (n = 16) 4-8 mg kg-1 h-1, isoflurane (n = 16) or desflurane (n = 16) for maintenance of anaesthesia. ⋯ IOP was measured before surgery, during maintenance and after emergence from anaesthesia with applanation tonometry by an ophthalmologist blinded to the anaesthetic technique. There was a significant decrease in IOP after induction of anaesthesia which did not differ between groups. Desflurane maintained IOP at an equivalent level to isoflurane and propofol.
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Randomized Controlled Trial Clinical Trial
Blood salvage during caesarean section.
The aim of this study was to assess blood salvage during Caesarean section. In 15 Caesarean sections, red cells lost were collected and washed with a Dideco machine and tested for the presence of fetoplacental material, bacterial contamination, free haemoglobin and fetal blood cells. Successive patients were allocated randomly to one of two groups. ⋯ Duration of hospital stay was significantly shorter in group 1 (5.3 (1.9) vs 7.3 (4) days; P = 0.003). Mean base haemoglobin concentrations were significantly lower in group 1 (10.7 (1.4) vs 11.7 (1.5) g dl-1; P > 0.0001), while after surgery mean haemoglobin concentrations were significantly higher approximately 3 h after operation compared with the control group (10.2 (1.5) vs 8.6 (1.2) g dl-1; P < 0.0001). On the first day, haemoglobin concentrations were 9.8 (1.5) vs 8 (1.4) g dl-1 (P < 0.0001), on the second day 9.8 (1.4) vs 7.7 (1.4) g dl-1 (P < 0.0001), on the third day 10.1 (1.5) vs 7.5 (1.3) g dl-1 (P < 0.0001) and on the fourth day 10.4 (1.5) vs 8.1 (1.4) g dl-1 (P < 0.0001).