British journal of anaesthesia
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Sedation is an important component of patient comfort in the intensive care unit (ICU), especially in those undergoing mechanical ventilation. Sedation that is too light or too deep can have important consequences, and therefore assessment of the degree of sedation should be an important part of patient management. Although there are many methods available to assess the degree of sedation, none is ideal. ⋯ There were no significant differences in mean or highest levels between patients in the two phases (mean 2.89 (SD 0.11) vs 2.67 (0.13), P = 0.22; highest 3.16 (0.11) vs 3.10 (0.14), P = 0.78). However, the lowest level was significantly greater in patients in the second phase than in those in the first phase (2.61 (0.11) vs 2.16 (0.13); P = 0.011), indicating that the number of patients with excessive sedation was significantly reduced with the introduction of this scale. Thus the use of this scale can have a real clinical impact for patients undergoing mechanical ventilation, principally by avoiding excessive sedation.
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Comment Letter Comparative Study
Effect of rocuronium compared with succinylcholine on IOP.
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Comment Letter Randomized Controlled Trial Clinical Trial
Opioid-induced pruritus: repeated vs single dose ondansetron administration in preventing pruritus after intrathecal morphine.
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It has been suggested previously that tramadol increases central nervous system activity and 'lightens' anaesthesia with volatile agents. We assessed the effects of tramadol on the minimum alveolar concentration (MAC) of isoflurane in 56 Wistar rats, instrumented chronically with an arterial and central venous catheter. The MAC of isoflurane was determined using the tail clamp method under three conditions: (1) after injection of saline (control); (2) after administration of tramadol 10 mg kg-1 i.v.; and (3) after administration of morphine 1 mg kg-1 i.v. ⋯ In contrast, after pretreatment with naloxone, tramadol (1.47 (0.04)%) or morphine (1.38 (0.07)%) did not cause a reduction in the MAC of isoflurane compared with controls (1.39 (0.06)%). We conclude that tramadol and morphine reduced the MAC of isoflurane to a small but significant extent. For both drugs, this effect was related to their action at opioid receptors.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of low-dose epidural with combined spinal-epidural analgesia for labour.
We have performed a randomized comparison of two low-dose epidural regimens for analgesia in labour, differing only in the manner in which initial analgesia was established. In the epidural (EPI) group, 484 women received a loading dose of 20 ml of 0.1% bupivacaine with fentanyl 2 micrograms ml-1. In the combined spinal-epidural (CSE) group, 524 women received a spinal injection of plain bupivacaine 2.5 mg with fentanyl 25 micrograms. ⋯ Other comparisons between groups revealed no differences. These findings may have been affected by an uneven distribution of multiparous women between the groups (25% in the EPI group and 34.2% in the CSE group; P = 0.002). However, subgroup analysis of primiparous and multiparous women did not alter the results.