British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Effect of omitting regular ACE inhibitor medication before cardiac surgery on haemodynamic variables and vasoactive drug requirements.
Adverse events during coronary artery bypass graft (CABG) surgery have been described in patients receiving angiotensin converting enzyme (ACE) inhibitors, including hypotension on induction of anaesthesia and an increase in vasoconstrictor requirements after cardiopulmonary bypass (CPB). Omitting regular ACE inhibitor medication before surgery may improve cardiovascular stability during anaesthesia. We evaluated prospectively the effect of omitting regular ACE inhibitor medication before CABG surgery on haemodynamic variables and use of vasoactive drugs. ⋯ However, these patients required more vasodilators to control hypertension after CPB and in the early postoperative period. There was no difference in hypotension on induction of anaesthesia or in the use of vasoconstrictors after CPB. We conclude that omitting ACE inhibitors before surgery did not have sufficient advantage to be recommended routinely.
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Randomized Controlled Trial Clinical Trial
Sevoflurane anaesthesia causes a transient decrease in aquaporin-2 and impairment of urine concentration.
Sevoflurane anaesthesia is occasionally associated with polyuria, but the exact mechanism of this phenomenon has not been clarified. Aquaporin-2 (AQP2) is an arginine vasopressin (AVP)-regulated water channel protein localized to the apical region of renal collecting duct cells and is involved in the regulation of water permeability. To elucidate the effect of sevoflurane anaesthesia on urine concentration and AQP2, we have compared serum and urinary concentrations of AVP, AQP2 and osmolar changes during sevoflurane and propofol anaesthesia. ⋯ Although urinary AQP2 excretion in the propofol group increased together with changes in plasma and urinary AVP, urinary AQP2 was significantly lower at 90 min in the sevoflurane group. Urine osmolality in the sevoflurane group also showed a transient but significant decrease in parallel with suppression of AQP2. Our data suggest that sevoflurane anaesthesia transiently produced an impaired AQP2 response to an increase in intrinsic AVP.
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Randomized Controlled Trial Clinical Trial
Dexamethasone reduces nausea and vomiting after laparoscopic cholecystectomy.
We have evaluated the antiemetic effect of i.v. dexamethasone compared with saline in the prevention of nausea and vomiting after laparoscopic cholecystectomy. We studied 90 patients requiring general anaesthesia for laparoscopic cholecystectomy, in a randomized, double-blind, placebo-controlled study. The dexamethasone group (n = 45) received dexamethasone 8 mg i.v. and the saline group received saline 2 ml i.v. at induction of anaesthesia. ⋯ We found that 10% of patients in the dexamethasone group compared with 34% in the saline group reported vomiting (P < 0.05). Of note, the total incidence of nausea and vomiting was 23% in the dexamethasone group and 63% in the saline group (P < 0.001). We conclude that dexamethasone 8 mg significantly decreased the incidence of nausea and vomiting after laparoscopic cholecystectomy.
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Randomized Controlled Trial Clinical Trial
Posterior epidural space depth: safety of the loss of resistance and hanging drop techniques.
We have compared skin to epidural space distance (SED) and tip to tip distance (TTD), a measure of posterior epidural space depth (PESD), in 40 patients with a 27-gauge Whitacre needle after identification of the epidural space using the hanging drop (HD) or loss of resistance (LOR) to air technique. After the LOR technique, TTD was found to be 2 mm greater than that after the HD technique, whereas SED was the same. We conclude that identification of the epidural space can be performed successfully with both techniques, but with a diminished risk of dural damage after LOR compared with the HD technique.
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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.