British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Pain on injection of rocuronium: influence of two doses of lidocaine pretreatment.
We have assessed the incidence of pain on injection of rocuronium and evaluated if pretreatment with lidocaine i.v. reduced it, in a randomized, controlled study in 90 patients. We found that 37% of patients who received lidocaine 10 mg pretreatment had pain on injection of rocuronium compared with 77% of patients who received saline pretreatment and 7% of patients who were pretreated with lidocaine 30 mg (P < 0.05 in each instance compared with control). In addition, patients pretreated with lidocaine were less likely to suffer moderate or severe pain. Both lidocaine 10 mg and 30 mg i.v. given before administration of rocuronium significantly reduced the incidence and severity of pain on injection of rocuronium, and the higher dose was more effective.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of different doses of remifentanil on the cardiovascular response to laryngoscopy and tracheal intubation.
We have compared three bolus and infusion regimens of remifentanil on the cardiovascular response to laryngoscopy and orotracheal intubation in three groups of 20 ASA I-II female patients, in a randomized, double-blind study. Patients in group 1 received glycopyrolate 200 micrograms i.v. followed by a bolus dose of remifentanil 1 microgram kg-1 over 30 s and an infusion of remifentanil at a rate of 0.5 microgram kg-1 min-1. The other patients received remifentanil 0.5 microgram kg-1 over 30 s and an infusion of 0.25 microgram kg-1 min-1 with (group 2) or without (group 3) pretreatment with glycopyrrolate 200 micrograms. ⋯ Baseline heart rate was similar in all groups, but decreased in group 3 (no glycopyrrolate) after induction and remained significantly lower after intubation compared with the other groups (P < 0.05). Heart rate and arterial pressure increased slightly after intubation in each group but there were no significant differences in mean arterial pressure between groups at any time. The incidence of bradycardia (one patient in group 2) and hypotension (two patients in groups 1 and 2 and three patients in group 3) was low.
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Randomized Controlled Trial Comparative Study Clinical Trial
Fentanyl augments block of sympathetic responses to skin incision during sevoflurane anaesthesia in children.
We studied 61 healthy ASA 1 patients (aged 2-6 yr) to determine if fentanyl affects the minimum alveolar concentration which blocks adrenergic responses to skin incision (MAC-BAR) in 50% of children in the presence of 60% nitrous oxide. Patients were allocated randomly to one of three fentanyl groups to receive 0, 2 or 4 micrograms kg-1. Patients also received sevoflurane at a preselected end-tidal concentration according to an 'up-and-down' design. ⋯ The response was considered positive if heart rate (HR) or mean arterial pressure (MAP) increased by 15% or more. The MAC-BAR of sevoflurane was 1.45 MAC (95% confidence intervals 1.25-1.65 MAC), and this was reduced markedly to 0.63 MAC and 0.38 MAC by addition of fentanyl 2 and 4 micrograms kg-1, respectively. A ceiling effect was not observed and there was a significant difference between the 2 and 4 micrograms kg-1 groups.
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Randomized Controlled Trial Comparative Study Clinical Trial
Hyperbaric bupivacaine for spinal anaesthesia in 7-18 yr old children: comparison of bupivacaine 5 mg ml-1 in 0.9% and 8% glucose solutions.
We have compared two hyperbaric bupivacaine solutions for spinal anaesthesia in 7-18-yr-old school-aged children in a double-blind, randomized, parallel group, prospective study. Children were premedicated with diazepam orally. Half of the patients were sedated with either midazolam or thiopental. ⋯ Six children were given etilefrin to treat hypotension and six atropine for bradycardia. Nausea was associated with a high level of block. Shivering was detected in 16 children.
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Randomized Controlled Trial Clinical Trial
A placebo-controlled study of the effects of dopexamine on gastric mucosal perfusion in infants undergoing hypothermic cardiopulmonary bypass.
We used a laser Doppler probe to measure gastric mucosal blood flow (flux) and a paediatric tonometer to intermittently calculate gastric-arterial PCO2 difference (PrCO2-PaCO2 gap) in 50 infants aged 0.3-52 weeks who required hypothermic cardiopulmonary bypass (CPB). During CPB, patients in group 2 (n = 25) were given dopexamine 1.0 mg kg-1 over 5 min, followed by an infusion of 2 micrograms kg-1 min-1. Patients in group 1 (n = 25) received an equal volume of saline. ⋯ Similarly, mean PrCO2-PaCO2 gap increased significantly from 3.6 (6.3) to 8.2 (6.7) in group 1 (P = 0.01) compared with a significant decrease from 5.8 (5.5) to 2.1 (5.5) in group 2 (P = 0.02). Mean PrCO2-PaCO2 gap after rewarming in group 2 was significantly higher than that in group 1 (P = 0.001). These data indicate that dopexamine may be useful in maintaining normal gut perfusion in infants requiring hypothermic CPB.