British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Dexamethasone is a cost-effective alternative to ondansetron in preventing PONV after paediatric strabismus repair.
This study evaluated the antiemetic efficacy, cost-effectiveness and clinical utility of prophylactic ondansetron and dexamethasone compared with placebo in the prevention of postoperative nausea and vomiting (PONV) in 135 children (2-15 yr, ASA I-II) undergoing strabismus repair. After induction with halothane and nitrous oxide in oxygen or i.v. thiopental, the children received i.v. dexamethasone 1 mg kg(-1) to a maximum of 25 mg, ondansetron 100 microg kg(-1) to a maximum of 4 mg or placebo (n=45). Episodes of PONV were recorded for the first 24 h after the operation. ⋯ The incidence (P=0.04) and severity (P=0.03) of PONV at the 6-24 h epoch were significantly less in the dexamethasone group than in the ondansetron group. Recovery time (P=0.07), fast tracking time (P=0.6), parental satisfaction scores (P=0.08) and NNTP PONV were comparable (NNTP=2) in both the ondansetron and the dexamethasone group. The cost to benefit a child with dexamethasone was approximately 22 times less than that of ondansetron.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of effects of remifentanil and alfentanil on cardiovascular response to tracheal intubation in hypertensive patients.
In a randomized double-blind study, we compared the effect of remifentanil and alfentanil on the cardiovascular response to laryngoscopy and tracheal intubation in patients on long-term treatment for hypertension. Forty ASA II-III patients were allocated to receive (i) remifentanil 0.5 microg kg(-1) followed by an infusion of 0.1 microg kg min(-1) or (ii) alfentanil 10 microg kg(-1) followed by an infusion of saline; all patients received glycopyrrolate 200 microg before the study drug. Anaesthesia was induced with propofol and rocuronium and maintained with 1% isoflurane and 66% nitrous oxide in oxygen. ⋯ There were no incidences of bradycardia. Seven patients in the remifentanil group and four in the alfentanil group received ephedrine for hypotension (i.e. SAP<100 mm Hg).
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of coagulation and blood loss during anaesthesia with inhaled isoflurane or intravenous propofol.
Propofol has been reported to affect blood coagulation. This prospective, randomized study compared coagulation and blood loss during anaesthetic maintenance with target-controlled intravenous propofol infusion vs. inhaled isoflurane. Thirty-eight ASA I-III patients undergoing head and neck surgery were allocated randomly to receive either inhaled isoflurane at end-tidal concentration 1-1.5% (group I, n=20) or target-controlled infusion (TCI) of propofol at target concentration 2-5 microg ml(-1) (group P, n=18). ⋯ Total blood loss was also not significantly different (median group I: 350 ml, range 20-1200 ml; group P: 200 ml, range 50-800 ml). Shortening of R-time and widening of angle developed over time in both groups (P<0.05 groups I and P, repeated measures ANOVA). We conclude that maintenance of anaesthesia with propofol TCI at 2-5 microg ml(-1) does not cause detectable coagulation changes on thrombelastography nor increase surgical blood loss when compared to inhaled isoflurane.
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Randomized Controlled Trial Clinical Trial
Effects of different concentrations of sevoflurane and desflurane on subcortical somatosensory evoked responses in anaesthetized, non-stimulated patients.
Twenty-four patients were recruited and given either sevoflurane or desflurane as their sole anaesthetic. Each patient was given sequentially increasing or decreasing doses at 0.5 MAC intervals, and the median nerve somatosensory evoked response recorded after an equilibration at each concentration. The N20-P25 and P25-N35 amplitudes decreased with increasing agent concentration. ⋯ The peak inflection points were at 3.2% for sevoflurane and 4.9% for desflurane. There were no differences between the ascending and descending groups. This increase in activity in the midbrain at 'surgical' end-tidal anaesthetic concentrations suggests more complex neuroelectrical responses to anaesthesia than simple global suppression.
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Randomized Controlled Trial Clinical Trial
Effects of sevoflurane and propofol on pulmonary shunt fraction during one-lung ventilation for thoracic surgery.
Forty patients requiring one-lung ventilation (OLV) for thoracic surgery were randomly assigned to receive propofol (4-6 mg kg(-1) h(-1)) or sevoflurane (1 MAC) for maintenance of anaesthesia. Three sets of measurements were taken: (i) after 30 min of two-lung ventilation (TLV), (ii) after 30 min of one-lung ventilation (OLV-1) in the supine position and (iii) during OLV in the lateral position (OLV-2) with the chest open and before surgical manipulation of the lung. ⋯ Cardiac index and other haemodynamic and respiratory variables were similar for the two groups. We conclude that inhibition of hypoxic pulmonary vasoconstriction by sevoflurane may only account for small increases in shunt fraction and that much of the overall shunt fraction during OLV has other causes.