British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Intrathecal sufentanil and morphine for post-thoracotomy pain relief.
In this double-blind randomized study we compared a group of 15 patients undergoing thoracotomy who received a spinal injection of sufentanil 20 microg combined with morphine (200 microg) after induction of general anaesthesia with a control group of the same size. Post-operative pain was rated on a visual analogue scale (VAS) and a verbal rating scale at rest and with a VAS on coughing. In the recovery room, patients received titrated i.v. morphine until the VAS score was <30, and were followed by patient-controlled analgesia (PCA) for 72 h. ⋯ There were no differences after this time. Spirometric data (peak expiratory flow, forced vital capacity and forced expiratory volume in 1 s) were similar in the two groups. We conclude that the combination of intrathecal sufentanil and morphine produces analgesia of rapid onset and with a duration of 24 h.
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Randomized Controlled Trial Comparative Study Clinical Trial
Sevoflurane EC50 and EC95 values for laryngeal mask insertion and tracheal intubation in children.
The laryngeal mask airway (LMA) is a simple, easy to use and safe method for airway control in children. Its insertion needs less anaesthetic, and haemodynamic responses and postoperative sequelae are less than with laryngoscopy and tracheal intubation. This study was designed to determine the end-tidal concentrations of sevoflurane where 50% (EC50) and 95% (EC95) of the attempts to secure the airway would be successful. ⋯ Sevoflurane provided good conditions for both LMA insertion, and laryngoscopy and tracheal intubation without serious adverse effects. The EC50 and the EC95 of sevoflurane were 1.57 (SD 0.33)% and 2.22% for LMA insertion and 2.20 (SD 0.31)% and 2.62% for laryngoscopy and tracheal intubation. Thus, less sevoflurane is required for LMA insertion in children than for laryngoscopy and tracheal intubation.
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Randomized Controlled Trial Clinical Trial
Haemodynamic and renal effects of intravenous enalaprilat during coronary artery bypass graft surgery in patients with ischaemic heart dysfunction.
Renal dysfunction occurring after open heart surgery is multifactorial in origin but activation of the renin-angiotensin system may have a prominent role. Fourteen patients with ischaemic heart dysfunction scheduled for elective coronary artery bypass graft (CABG) surgery were allocated to a treatment group [enalaprilat for 2 days; ACEI (angiotensin-converting enzyme inhibitor) group, n=7] or a control group (n=7). The cardiac index was significantly higher in ACEI-treated patients than in the controls before and after cardiopulmonary bypass (CPB) (P<0.05) and on postoperative day 2 (P<0.05). ⋯ The study demonstrates that administration of an i.v. ACEI, enalaprilat, improves cardiac output during CABG surgery in patients with ischaemic heart dysfunction. Moreover, renal perfusion was better maintained during surgery, and this effect was sustained up to post-operative day 7.
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Randomized Controlled Trial Comparative Study Clinical Trial
Spinal anaesthesia with ropivacaine 5 mg ml(-1) in glucose 10 mg ml(-1) or 50 mg ml(-1).
Forty patients undergoing spinal anaesthesia for a variety of surgical procedures were randomly allocated to receive 3 ml of ropivacaine 5 mg ml(-1) in glucose 10 mg ml(-1) or 50 mg ml(-1). Onset of sensory block to T10 was significantly faster (P=0.03) with the glucose 50 mg ml(-1) solution (median 5 min, range 2-20 min) than with the 10 mg ml(-1) solution (median 10 min, range 2-25 min). ⋯ Complete motor block was produced in the majority of patients (10 mg ml(-1) 90%; 50 mg ml(-1) 85%) and the time to complete regression was the same in both groups (median 120 min, range 90-210 min). A block adequate for the projected surgery was achieved in all patients.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparing the effects of stimulation and propofol infusion rate on implicit and explicit memory formation.
Doubt remains about the conditions under which learning persists despite anaesthesia. This study investigated the relative importance of dose of anaesthetic and stimulation for learning during propofol infusion before surgery. Thirty-six patients were randomly assigned to three groups. ⋯ To establish baseline, a control group of 12 patients completed the category generation test without receiving the category examples during anaesthesia. Overall, there was no evidence for learning during propofol infusion, though the category generation task showed a trend towards more implicit memory for words presented during intubation than during anaesthesia. We conclude that learning does not occur during anaesthesia without surgery.