British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial Controlled Clinical Trial
Prophylactic antiemetic effect of dexamethasone in women undergoing ambulatory laparoscopic surgery.
The aim of this study was to evaluate the prophylactic antiemetic effect of i.v. dexamethasone in women undergoing ambulatory laparoscopic tubal ligation. Ninety patients requiring general anaesthesia for laparoscopic tubal ligation were enrolled in a randomized, double-blind, placebo-controlled study. Forty-five patients received dexamethasone 10 mg i.v. and 45 received saline 2 ml i.v. at the induction of anaesthesia. ⋯ Seven per cent of patients in the dexamethasone group, compared with 28% of patients in the saline group, received a rescue antiemetic (P < 0.05). During the 24-h postoperative observation period, 34% of patients in the dexamethasone group, compared with 73% of patients in the saline group, reported nausea and vomiting (P < 0.001). We conclude that dexamethasone 10 mg significantly decreases the incidence of postoperative nausea and vomiting in women undergoing ambulatory laparoscopic tubal ligation.
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Meta Analysis
General versus regional anaesthesia for hip fracture surgery: a meta-analysis of randomized trials.
Hip fracture surgery is common and the population at risk is generally elderly. There is no consensus of opinion regarding the safest form of anaesthesia for these patients. We performed a meta-analysis of 15 randomized trials that compare morbidity and mortality associated with general or regional anaesthesia for hip fracture patients. ⋯ No other outcome measures reached a statistically significant difference. There was a tendency towards a lower incidence of myocardial infarction, confusion and postoperative hypoxia in the regional anaesthetic group, and cerebrovascular accident and intra-operative hypotension in the general anaesthetic group. We conclude that there are marginal advantages for regional anaesthesia compared to general anaesthesia for hip fracture patients in terms of early mortality and risk of deep vein thrombosis.
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Randomized Controlled Trial Clinical Trial
Randomized placebo-controlled trial to assess the effect of remifentanil and propofol on bispectral index and sedation.
The effect of the combination of opiates and hypnotics on bispectral index (BIS) is unclear. This double-blind placebo-controlled trial investigated the effect on BIS and sedation of different infusion doses of remifentanil combined with a steady infusion of propofol. Forty patients initially received a target-controlled infusion of propofol 2 micrograms ml-1 for 15 min. ⋯ We found a significant correlation between the dose of remifentanil and the change of BIS after 15 min of infusion. The correlation between all the sedation scores and their corresponding BIS was also significant. We concluded that remifentanil, in combination with propofol, reduces BIS when used for sedation.
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A 23-yr-old primagravida sustained a dural puncture during epidural catheter insertion and developed a headache that settled with oral diclofenac and codydramol. On the third day after delivery, she convulsed twice without warning. As plasma urate was increased, the putative diagnosis of an eclamptic fit was made, and magnesium therapy was started. ⋯ A coincidental arteriovenous malformation was noted. This case emphasises the need to consider the differential diagnoses of post-partum headache. The management of acute intracranial haematoma is described.
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Randomized Controlled Trial Comparative Study Clinical Trial
Novel bioadhesive delivery system for percutaneous local anaesthesia.
We have assessed the efficacy of a novel bioadhesive amethocaine patch device, compared to Ametop gel, in a randomized, double-blinded trial. Patch and gel formulations, including placebos, were applied to the forearms of volunteers (n = 30) for 40 min. Once the formulations were removed from the skin, anaesthesia was assessed by volunteers using a conventional pinprick test. ⋯ Statistical analysis of the results indicated that both amethocaine gel and patch preparations were superior to placebo (P < 0.05). No significant difference was observed between amethocaine gel and patch formulations (P > 0.05) in either onset time or duration of action for percutaneous local anaesthesia. The results of this study indicate therefore that the novel bioadhesive patch provides clinically comparable anaesthesia to the established gel formulation in a more defined dosage form.