British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Recovery after remifentanil and sufentanil for analgesia and sedation of mechanically ventilated patients after trauma or major surgery.
We investigated the analgesic effect and the neurological recovery time after administration of remifentanil in mechanically ventilated patients in an intensive care unit. Twenty patients, after trauma or major surgery with no intracranial pathology, were randomized to receive either remifentanil/propofol (n=10) or sufentanil/propofol (n=10). A sedation score and a simplified pain score were used to assess adequate sedation and analgesia. ⋯ During the following 20 min, all patients with remifentanil emerged from sedation and complained of considerable pain. By contrast, in the sufentanil group, only six (7) responded to commands after 10 (30) min and their pain score remained essentially unchanged during the 30-min observation period. We conclude that, in contrast to sufentanil, remifentanil facilitates rapid emergence from analgesia and sedation, allowing a clinical neurological examination within 10-30 min in mechanically ventilated patients with no intracranial pathology.
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Randomized Controlled Trial Clinical Trial
Effect of intravenous magnesium on pain and secondary hyperalgesia associated with the heat/capsaicin sensitization model in healthy volunteers.
We investigated the effects of i.v. magnesium on secondary hyperalgesia following heat/capsaicin stimulation in human volunteers. Twenty-five volunteers were included in this double blind, randomized, crossover study. ⋯ In contrast, painfulness of thermal stimulation was increased in normal skin. These results suggest that i.v. magnesium has no important analgesic effects in clinically relevant doses.
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Intracranial subdural haematoma is an exceptionally rare complication of spinal anaesthesia. A 20-yr-old male underwent appendicectomy under partial spinal and subsequent general anaesthesia. A week later, he presented with severe headache and vomiting not responding to bed rest and analgesia. ⋯ The patient improved without surgical decompression. The pathogenesis of headache and subdural haematoma formation after dural puncture is discussed and the literature briefly reviewed. Severe and prolonged post-dural puncture headache should be regarded as a warning sign of an intracranial complication.
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Randomized Controlled Trial Comparative Study Clinical Trial
Infusion of amino acid enriched solution hastens recovery from neuromuscular block caused by vecuronium.
We investigated the effect of an amino acid infusion on neuromuscular block produced by vecuronium, and on rectal temperature and surface temperature over the adductor pollicis muscle. Sixty adult patients undergoing general anaesthesia were randomly divided into four groups of 15 patients each: amino acid (AA)-post-tetanic count (PTC); AA-train-of-four (TOF); control (C)-PTC; or C-TOF group. In the AA-PTC and AA-TOF groups, after a bolus of vecuronium 0.1 mg kg(-1), a continuous infusion of an 18 amino acid enriched solution (AMIPAREN) was started at a rate of 166 kJ h(-1). ⋯ T1/T0 and T4/T1 in the AA-TOF group were significantly higher than in the C-TOF group, 40-120 and 50-120 min after vecuronium respectively (P<0.05). Rectal temperature and surface temperature over the adductor pollicis muscle in the AA-PTC and AA-TOF groups were significantly higher than in the control groups 50-120 and 100-120 min after vecuronium respectively (P<0.05). Infusion of amino acid enriched solution hastens recovery from neuromuscular block.
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Sevoflurane is widely used in anaesthetic protocols for patients undergoing surgical procedures. However, there are no reports on the influence of sepsis on minimum alveolar concentration of sevoflurane (MAC(SEV)) in animals or in humans. The aim of this study was to test the hypothesis that sepsis could alter the MAC(SEV) in a normotensive septic pig model. ⋯ Significant increases in mean artery pulmonary pressure, filling, epinephrine and vascular pulmonary resistances occurred in the sepsis group. MAC(SEV) for the saline group was 2.4% [95% confidence interval (CI) 2.1-2.55%] and the MAC(SEV) for the sepsis group was 1.35% (95% CI 1.2-1.45%, P<0.05). These data indicate that MAC(SEV) is significantly decreased in this normotensive septic pig model.