British journal of anaesthesia
-
Randomized Controlled Trial Clinical Trial
Prevention of postoperative nausea and vomiting by continuous infusion of subhypnotic propofol in female patients receiving intravenous patient-controlled analgesia.
In this prospective, randomized, double-blind, placebo-controlled study, the use of continuous subhypnotic propofol infusion as an antiemetic in fentanyl intravenous patient-controlled analgesia (i.v. PCA) was investigated during the first 24 h after surgery. One hundred female patients, ASA I-II, aged 20-71 yr, undergoing major gynaecological or orthopaedic surgery, were included. ⋯ PCA was started in the postanaesthesia care unit for postoperative analgesia. Significantly more of the patients given propofol 15 and 20 microg kg(-1) min(-1) experienced no nausea or vomiting compared with those given placebo (65% and 70% versus 25%; P<0.05). Patients given propofol 20 microg kg(-1) min(-1) reported more sedation than those in the other groups 4 h after surgery (P<0.05).
-
Randomized Controlled Trial Comparative Study Clinical Trial
Pain management after adenoidectomy with ketoprofen: comparison of rectal and intravenous routes.
We compared the efficacy of rectally and intravenously administered ketoprofen for pain management after day-case adenoidectomy. Patients (123 children aged 1-9 yr) were allocated randomly to receive on induction of anaesthesia ketoprofen 25 mg rectally with an i.v. placebo, ketoprofen 25 mg i.v. with a rectal placebo, or placebo both i.v. and rectally. The method of anaesthesia and the operative technique were standardized. ⋯ There was no significant difference between the two ketoprofen groups in their requirement for rescue analgesics. However, both the proportion of children needing rescue analgesics [55 of 84 children (65%) vs. 33 of 39 children (84%); difference 19%, 95% confidence interval 4-34%, P=0.029] and the number of rescue analgesic doses [mean 1.2 (SD 1.2) vs. 2.2 (1.4); mean difference 0.9, 95% confidence interval 0.4-1.4, P=0.001] were significantly lower among children receiving ketoprofen than in children receiving placebo. Adverse events, duration of operation, perioperative bleeding, pain scores and time of discharge were similar in the three groups.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Ropivacaine 0.2% versus bupivacaine 0.1% with fentanyl: a double blind comparison for analgesia during labour.
We have performed a randomized, double-blind comparison of two epidural drug regimens for analgesia in labour. In the bupivacaine group (BUPIV), 101 healthy parturients received 0.1% bupivacaine with fentanyl 2 microg ml(-1). In the ropivacaine group (ROPIV), 102 women received 0.2% ropivacaine. ⋯ The ropivacaine group was more likely to be pain free in the first stage (51% vs. 33.7%, P=0.01). There were no significant differences in patients' assessment of motor block or mode of delivery between the groups. Pain relief and satisfaction scores from midwives and patients were consistently better in the ropivacaine group, but did not reach statistical significance.
-
Randomized Controlled Trial Clinical Trial
Dexamethasone for prophylaxis of nausea and vomiting after epidural morphine for post-Caesarean section analgesia: comparison of droperidol and saline.
We have evaluated the prophylactic effect of i.v. dexamethasone 8 mg in preventing nausea and vomiting during epidural morphine for post-Caesarean section analgesia. Droperidol 1.25 mg and saline served as the control. ⋯ Both dexamethasone and droperidol significantly decreased the total incidence of nausea and vomiting compared with saline, with incidences of 18, 21 and 51% for the three treatments respectively (P<0.01 and P<0.05 respectively). Parturients who received droperidol reported a more frequent incidence of restlessness (16%) than those who received dexamethasone (P<0.05).
-
Randomized Controlled Trial Clinical Trial
Model-based automatic feedback control versus human control of end-tidal isoflurane concentration using low-flow anaesthesia.
We studied the clinical use of an automatic feedback control system to adjust the end-tidal anaesthetic concentration with a low-flow method. The end-tidal controller uses two input signals (the end-tidal and inspiratory concentrations) to control the isoflurane concentration in the fresh gas flow, using a model-based algorithm. We studied 22 ASA I-III patients during elective surgery lasting more than 2 h. ⋯ The automatic control system was more accurate and stable than the human controller for step increases and step decreases, with less overshoot/undershoot and greater stability [e.g. maximal overshoot 14.7 (SD 3.7)% and 18 (8.1)% respectively for +0.6 vol% step changes, and 19.8 (3.7)% and 30.7 (13.2)% respectively for +0.3 vol% step changes]. However, the automatic control system showed a faster response time than the manual method only with large increasing steps (e.g. 149 (32) s and 205 (57) s respectively for +0.6 vol% step changes) and was not different from manual control for decreasing steps. Automatic control of the end-tidal isoflurane concentration can be better than human control in a clinical setting, and this task could be done automatically.