British journal of anaesthesia
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Editorial Comment
Cost effectiveness of general anaesthesia: inhalation vs i.v.
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Randomized Controlled Trial Multicenter Study Clinical Trial
A multicentre comparison of the costs of anaesthesia with sevoflurane or propofol.
Day-case anaesthesia requires rapidly eliminated anaesthetics which are relatively expensive. This multinational, multicentre European study assessed the relative costs of propofol or sevoflurane anaesthesia in 211 patients. Anaesthesia was induced and maintained with propofol in group 1, with propofol and sevoflurane in group 2, and with sevoflurane in group 3. ⋯ Anaesthetic drug wastage and disposable costs were highest in group 1 and lowest in group 3. Consequently, total costs were highest in group 1 ($31.9 (0.9)) compared with groups 2 ($19.7 (0.9)) and 3 ($18.8 (0.9)). Although we observed increased nausea and vomiting in groups 2 and 3 and reduced patient satisfaction in group 3, these differences should be balanced against the greater cost of propofol anaesthesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of ondansetron and cyclizine for prevention of nausea and vomiting after day-case gynaecological laparoscopy.
We have compared ondansetron 4 mg i.v. and cyclizine 50 mg i.v., in a double-blind, randomized, placebo-controlled study for the prevention of postoperative nausea and vomiting (PONV) for 24 h after day-case gynaecological laparoscopy. Compared with placebo (n = 58), ondansetron (n = 60) and cyclizine (n = 57) reduced significantly the incidence of moderate or severe nausea (30% and 23% vs 52%; P = 0.02 and P = 0.001, respectively) and requirement for escape antiemetic (28% and 16% vs 47%; P = 0.04 and P < 0.001, respectively) before discharge from hospital. ⋯ For diagnostic laparoscopy (n = 74), fewer patients received escape antiemetic after cyclizine than after ondansetron (4% vs 37%; P < 0.01); for laparoscopic sterilization (n = 101), both antiemetics were equally effective. Ondansetron and cyclizine both reduced severe and moderate nausea and the need for antiemetic therapy after day-case gynaecological laparoscopy.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of breathing methods for inhalation induction of anaesthesia.
We studied healthy female patients, allocated randomly to three breathing regimens for induction of anaesthesia using sevoflurane and oxygen from a co-axial Mapleson D breathing system and a mask, to test the hypothesis that rebreathing reduces the incidence of apnoea associated with loss of consciousness. The non-rebreathing group received sevoflurane in oxygen 6 litre min-1 from the start, doubling in concentration from 0.5% to 8% every 3 breaths. The second group received oxygen 6 litre min-1 for 1 min before sevoflurane was introduced, and the third group received oxygen 3 litre min-1 for 1 min before sevoflurane. ⋯ Apnoea occurred in five of 15 patients who did not receive oxygen before sevoflurane and in four of 13 who received oxygen 6 litre min-1 (P < 0.05). No patient showed a reduction in pulse oximeter saturation. We conclude that inhalation induction of anaesthesia can be performed reliably in approximately 3 min using sevoflurane in oxygen 3 litre min-1.
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Randomized Controlled Trial Clinical Trial
Effect of tropisetron on vomiting during patient-controlled analgesia in children.
Patient-controlled analgesia (PCA) is associated with a high incidence of vomiting which is distressing and interferes with postoperative recovery. Tropisetron, a long-acting selective 5-HT3 receptor antagonist, has been shown to be effective in preventing nausea and vomiting associated with PCA use in adults and chemotherapy in children. We assessed the efficacy of prophylactic intraoperative administration of tropisetron on the incidence of vomiting in children using morphine PCA. ⋯ Children who received tropisetron had an incidence of vomiting during the first 24 h after operation of 22% compared with 66% in the control group (P = 0.001). In addition, the severity of vomiting was less in the tropisetron group with only one child (4%) vomiting more than twice compared with nine (31%) in the control group (P = 0.01). We conclude that tropisetron is efficacious in reducing the incidence and severity of postoperative vomiting in children using PCA.