British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Orally administered clonidine significantly reduces pain during injection of propofol.
We examined the analgesic effects of orally administered clonidine on pain induced by injection of propofol (Diprivan; 2,6-diisopropyl phenol). Female patients (n=81) were randomly allocated to one of two groups: oral clonidine (5.5 microg kg(-1)) followed by i.v. propofol and a control group given placebo followed by i.v. propofol. The median pain score in the group receiving clonidine, using a four-point scale (0=no pain, 1=minimal pain, 2=moderate pain, 3=severe pain) was 1 (0-2), significantly lower than in the control group [2 (1-3), median (25-75 percentiles), P<0.001].
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Comparative Study
Downward movement of syringe pumps reduces syringe output.
We studied how lowering a syringe pump and changing the outflow pressure could affect syringe pump output. We experimentally reduced the height of three different syringe pump systems by 80 cm (adult setting) or 130 cm (neonatal setting), as can happen clinically, using five flow rates. We measured the time of backward flow, no flow and the total time without flow. ⋯ The compliance of the different syringe pumps and their infusion systems was linearly correlated with the effective time without infusion (r2=0.863, P<0.05). We conclude that the height of the syringe pumps should not be changed during transportation. If vertical movement of the syringe pump is necessary, the drugs should be diluted so that the flow rate is at least 5 ml h(-1).
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Case Reports
Xenon anaesthesia for laparoscopic cholecystectomy in a patient with Eisenmenger's syndrome.
There are few reports on anaesthesia for patients with Eisenmenger's syndrome requiring non-cardiac surgery and none of the use of xenon. We describe the use of xenon with a closed-circuit system in a patient with Eisenmenger's syndrome having a laparoscopic cholecystectomy.
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Case Reports
Intramuscular ketamine in a parturient in whom pre-operative intravenous access was not possible.
We describe the management of a 23-yr-old woman with extreme needle and mask phobia, presenting for an emergency Caesarean section for fetal distress. She also suffered from spina bifida cystica with no sensation from mid thigh. Regional anaesthesia, rapid sequence induction, and gaseous induction were not possible. She was managed successfully with i.m. ketamine followed by a more conventional anaesthetic technique.
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Several risk scores have been developed to calculate the probability of postoperative nausea and vomiting (PONV). However, the power to discriminate which individual will suffer from PONV is still limited. Thus, we wondered how the number of predictors in a score affects the discriminating power and how the characteristics of a population--which is needed to measure the power of a score--may affect the results. ⋯ The currently available simplified risk scores (with four or five predictors) are useful both as a method to estimate individual risk of PONV and as a method for comparing groups of patients for antiemetic trials. They are also superior to single predictor models which are just using the patients' history of PONV or female gender alone. However, our analysis suggests that the power to discriminate which indvidual will suffer from PONV will remain imperfect, even when more predictors are considered.