British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Bolus dose remifentanil for control of haemodynamic response to tracheal intubation during rapid sequence induction of anaesthesia.
The effect of three bolus doses of remifentanil on the pressor response to laryngoscopy and tracheal intubation during rapid sequence induction of anaesthesia was assessed in a randomized, double-blind, placebo-controlled study in four groups of 20 patients each. After preoxygenation, anaesthesia was induced with thiopental 5-7 mg kg-1 followed immediately by saline (placebo) or remifentanil 0.5, 1.0 or 1.25 micrograms kg-1 given as a bolus over 30 s. Cricoid pressure was applied just after loss of consciousness. ⋯ Arterial pressure and heart rate were recorded at intervals until 5 min after intubation. Remifentanil 0.5 microgram kg-1 was ineffective in controlling the increase in heart rate and arterial pressure after intubation but the 1.0 and 1.25 micrograms kg-1 doses were effective in controlling the response. The use of the 1.25 micrograms kg-1 dose was however, associated with a decrease in systolic arterial pressure to less than 90 mm Hg in seven of 20 patients.
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Randomized Controlled Trial Comparative Study Clinical Trial
Levobupivacaine vs bupivacaine as infiltration anaesthesia in inguinal herniorrhaphy.
We have compared the anaesthetic and analgesic efficacy of levobupivacaine with that of racemic bupivacaine in 66 male patients undergoing ambulatory primary inguinal herniorrhaphy. Patients were allocated randomly in a double-blind manner to local infiltration anaesthesia (0.25% w/v 50 ml) with either racemic bupivacaine (n = 33) or levobupivacaine (n = 33). Scores for intraoperative pain and satisfaction with anaesthesia were recorded, together with perception of postoperative pain and need for supplementary postoperative analgesic medications in the first 48 h after operation. ⋯ Time averaged postoperative pain scores (48 h) were 8 (levobupivacaine) and 10 (bupivacaine) in the supine position, 13 (levobupivacaine) and 12 (bupivacaine) while rising from the supine position to sitting, and 9 (levobupivacaine) and 13 (bupivacaine) while walking (VAS; 100 mm = worst pain imaginable) (ns). There was no difference in the use of peroral postoperative analgesics between the two groups. We conclude that racemic bupivacaine and its S-enantiomer levobupivacaine had similar efficacy when used as local infiltration anaesthesia in inguinal herniorrhaphy.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of intrathecal and epidural diamorphine for elective caesarean section using a combined spinal-epidural technique.
To assess calculated equivalent doses of intrathecal and epidural opioids for elective Caesarean section in terms of quality and duration of analgesia, and incidence of side effects, we have compared 50 patients, allocated randomly to one of two groups to receive either diamorphine 0.25 mg intrathecally (group 1) or 5 mg epidurally (group 2), in addition to intrathecal bupivacaine 10 mg, using a combined spinal-epidural technique. There was no significant difference in duration of analgesia between groups (group 1 mean 14.6 (SD 5.9) h, group 2 14.2 (6.5) h; mean difference 0.8 h; 95% Cl -2.8-4.5; P = 0.65) or quality of analgesia (VAPS and VRS scores). The degree of pruritus was similar in both groups (80-88%) but the incidence of postoperative nausea and vomiting was significantly higher in the epidural group (24% vs 4%; P < 0.05). Intrathecal diamorphine 0.25 mg produced the same duration and quality of postoperative analgesia as epidural diamorphine 5 mg for elective Caesarean section but with significantly less nausea and vomiting.
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Randomized Controlled Trial Comparative Study Clinical Trial
Effect of propofol on the electrocorticogram in epileptic patients undergoing cortical resection.
We have compared the effect of clinical doses of propofol with thiopental on epileptiform activity in the electrocorticograms (ECoG) of 20 epileptic patients undergoing temporal lobe resection. After baseline ECoG had been obtained, with inspired concentrations of 0.5-1% isoflurane and 70% nitrous oxide to provide background anaesthesia, subjects were allocated randomly to receive boluses of either thiopental 25 mg or propofol 20 mg i.v. every 30 s to a maximum of 5 mg kg-1 or until burst suppression was seen. The ECoG was recorded throughout administration and for 10 min thereafter. ⋯ The amount of epileptiform activity was recorded on an ordinal rating scale, an increase being indicated by either a rise of at least one category on the scale or discharges occurring at a minimum of one new site. Activation occurred more frequently with thiopental but the difference was not significant. This study suggests that propofol has no greater proconvulsive effect than thiopental, a drug commonly used in managing status epilepticus.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Antiemetic activity of the NK1 receptor antagonist GR205171 in the treatment of established postoperative nausea and vomiting after major gynaecological surgery.
In this double-blind, randomized, parallel group study, we have investigated the antiemetic activity of the potent and selective NK1 receptor antagonist GR205171 25 mg i.v. compared with placebo in the treatment of established postoperative nausea and vomiting (PONV) in patients after major gynaecological surgery performed under general anaesthesia. The incidence of PONV in the study population was 65%. ⋯ The stimuli for emesis after PONV are multifactorial and the efficacy of GR205171 in this study supports the broad spectrum potential for NK1 receptor antagonists in the management of postoperative emesis. GR205171 was well tolerated and no adverse events were reported that would preclude the further development of this agent.