British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of intravenous and oral ketoprofen for postoperative pain after adenoidectomy in children.
One hundred children, aged 1-9 yr, undergoing adenoidectomy were randomized to receive ketoprofen 1 mg kg-1 either i.v. with an oral placebo (n = 40) or ketoprofen 1 mg kg-1 orally with an i.v. placebo (n = 40), or both oral and i.v. placebo (n = 20). The study design was prospective and double blind with parallel groups. The pain was assessed at rest and during swallowing using the Maunuksela pain scale (0 = no pain, 10 = worst possible pain) after surgery for 3 h. ⋯ Children in the i.v. group needed significantly less doses (1, 1-3; median and 10th/90th percentiles) of rescue analgesic compared with the oral group (2, 1-3; P = 0.024). Of those who needed rescue analgesic, three out of 30 children in the i.v. group required three or more doses of fentanyl compared with 10 out of 28 children in the oral group. There were no differences between the groups with respect to pain scores, operation times, perioperative bleeding or frequency of adverse events.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of succinylcholine with two doses of rocuronium using a new method of monitoring neuromuscular block at the laryngeal muscles by surface laryngeal electromyography.
We compared the onset of neuromuscular block with succinylcholine (1 mg kg-1) and two doses of rocuronium (0.6 and 0.9 mg kg-1) at the adductor pollicis muscle using electromyography (EMG) and acceleromyography (AMG), and at the adductor laryngeal muscles with a new electromyographic method using a disposable surface electrode attached to the cuff of a tracheal tube. At the larynx, the mean (+/- SD) time to 90% block and the onset time of succinylcholine (38 +/- 15 and 47 +/- 19 s, respectively) were significantly shorter (P < 0.01) than for rocuronium 0.6 mg kg-1 (92 +/- 42 and 106 +/- 38 s) and rocuronium 0.9 mg kg-1 (52 +/- 31 and 64 +/- 30 s). ⋯ Clinical duration at the adductor pollicis (AMG) was significantly longer (P < 0.01) for both rocuronium groups than for succinylcholine (T4:T1 = 0.7, 54 +/- 18 and 77 +/- 21 vs 8 +/- 6 min). The surface laryngeal electrode proved non-invasive, easy to use and reliable in measuring onset of the neuromuscular block at the larynx.
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Randomized Controlled Trial Clinical Trial
Randomized study of intravenous fluid preload before epidural analgesia during labour.
We performed a randomized controlled trial of the effect of intravenous fluid preload on maternal hypotension and fetal heart rate (FHR) changes in labour after the first epidural injection. Group 1 (49 women) received 1 litre of crystalloid preload. Group 2 (46 women) received no preload. ⋯ Deterioration in FHR pattern was found in four women in group 1 and 11 in group 2 (P = 0.08). This study has not shown a significant increase in the incidence of hypotension when intravenous preload is omitted before epidural analgesia using a low concentration of bupivacaine during labour. Because of the clinical importance of the difference in the rate of FHR deterioration between the two groups, we continue to administer preload for high-risk cases.
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The identification of a serum marker to assist in the diagnosis of cerebral injury after cardiac surgery is potentially useful. S100 protein is an early marker of cerebral damage. It is released after cardiac surgery performed under cardiopulmonary bypass (CPB). ⋯ Patients undergoing intracardiac operations combined with coronary artery bypass surgery are more susceptible to brain injury and have higher levels of S100 after CPB. Furthermore, adults and children undergoing deep circulatory arrest are more susceptible to brain injury, in terms of higher S100 protein release after CPB. Serum S100 protein levels are reduced after using arterial line filtration and covalent-bonded heparin to coat the inner surface of the CPB circuit.
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We investigated the safety of a patient-maintained system that allows individuals to operate a target-controlled infusion of propofol to achieve sedation. Ten healthy volunteers were recruited and instructed to try to anaesthetize themselves with the system. A target-controlled infusion of propofol was set to deliver a target propofol concentration of 1 microgram ml-1, and the subjects allowed to increase the target in increments of 0.2 microgram ml-1 by pressing a control button twice in 1 s. ⋯ Two subjects became oversedated, one of whom was unrousable with loss of eyelash reflex. No subject could recall the keyword, although one recognized it from a list of 10 words. We conclude that the patient-maintained sedation system described could not be guaranteed to produce only conscious sedation in all patients, and that close clinical supervision by an anaesthetist would still be required for safe operation.