British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Antiemetic prophylaxis in cardiac surgery: comparison of metoclopramide and ondansetron.
We have compared the effectiveness of ondansetron (115 patients) and metoclopramide (101 patients) for prevention of postoperative nausea and vomiting in patients undergoing cardiac surgery involving cardiopulmonary bypass. In a prospective, randomized, controlled, double-blind study, patients received oral ondansetron 16 mg or oral metoclopramide 10 mg, 1-2 h before surgery. ⋯ Compared with the metoclopramide group, the ondansetron group had a higher incidence of nausea (49.6% vs 33.7%; P < 0.05) and vomiting (42.6% vs 24.8%; P < 0.01). There was no difference between groups in the number of patients who accepted postoperative antiemetics (ondansetron 43.4% vs metoclopramide 32.6%) and there was no difference in the incidence of symptoms of moderate or severe nausea.
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Randomized Controlled Trial Comparative Study Clinical Trial
Combined spinal-epidural analgesia in labour: comparison of two doses of intrathecal bupivacaine with fentanyl.
We have compared intrathecal bupivacaine 1.25 mg and fentanyl 25 micrograms (group A) with bupivacaine 2.5 mg and fentanyl 25 micrograms (group B), for combined spinal-epidural analgesia in 49 labouring parturients in a prospective, randomized, double-blind study. Onset and quality of analgesia were similar in both groups, with median visual analogue scale pain scores of 0 achieved in 5-10 min. Median duration of analgesia was longer in group B (median 120 (range 90-120) min) compared with group A (75 (75-105) min) (P = 0.013). ⋯ Patient-midwife satisfaction scores and other side effects were similar. We conclude that intrathecal bupivacaine 1.25 mg with fentanyl 25 micrograms provided analgesia of similar onset and quality compared with bupivacaine 2.5 mg and fentanyl 25 micrograms. Although the duration of analgesia was shorter, the incidences of motor block and hypotension were less with the smaller dose.
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Randomized Controlled Trial Clinical Trial
Effect of oral and i.v. tenoxicam in postoperative pain after total knee replacement.
We have evaluated the effect of oral and i.v. tenoxicam on postoperative pain after unilateral total knee replacement in a double-blind, randomized, controlled study. Tenoxicam was administered to two groups of patients, either before (40 mg orally) or after (40 mg i.v.) surgery, then at 24 h after surgery (40 mg i.v.) and at the end of each day for 8 days (20 mg orally). A third group were given placebo at all times. ⋯ There was no significant reduction in the requirement for PCA morphine for the duration of the study in either of the treatment groups, or for co-dydramol in the first 2 days, but tenoxicam significantly reduced the need for co-dydramol over the remaining 7 days. There were no significant differences in mobility between groups. There was a high incidence of adverse events reported, with a similar number in each of the three groups.
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Case Reports
Malposition of the epiglottis after tracheal intubation via the intubating laryngeal mask.
The intubating laryngeal mask has been reported to be a successful method of tracheal intubation although advancement of the tracheal tube via the laryngeal inlet into the trachea cannot be seen. Damage to the larynx or other tissues may occur during blind passage of a tracheal tube. We report a case in which the tracheal tube, advanced blindly, tucked the epiglottis into the laryngeal inlet, resulting in oedema of the epiglottis. This case illustrates the potential for airway obstruction after extubation when using the intubating laryngeal mask as a blind intubation guide.
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Comparative Study
Improving the shape and compliance characteristics of a high-volume, low-pressure cuff improves tracheal seal.
A prototype design of a compliant latex, high-volume, low-pressure cuffed tracheal tube cuff (CHVLP) was compared with the Mallinckrodt Hi-Lo, Sheridan preformed and Portex Profile high-volume, low-pressure (HVLP) cuffed tracheal tubes for leakage of dye placed above the cuff in a benchtop mechanical ventilation model and in five isolated pig tracheas. There was no leakage in the ventilation model or in the pig tracheas with the prototype CHVLP. There was rapid leakage in the ventilation model and in all the pig tracheas for the Mallinckrodt Hi-Lo, the Sheridan preformed and the Portex Profile cuffs. This benchtop study suggests that improved HVLP cuff compliance characteristics may be beneficial in the prevention of leakage of fluid to the lungs known to occur with HVLP cuffs.