British journal of anaesthesia
-
Randomized Controlled Trial Clinical Trial
Effect of intrathecal tramadol administration on postoperative pain after transurethral resection of prostate.
Tramadol administered epidurally has been demonstrated to decrease postoperative analgesic requirements. However, its effect on postoperative analgesia after intrathecal administration has not yet been studied. In this double-blind, placebo-controlled study, the effect of intrathecal tramadol administration on pain control after transurethral resection of the prostate (TURP) was studied. ⋯ Intrathecal tramadol was not different from saline in its effect on postoperative morphine requirements after TURP.
-
Isoflurane and propofol reduce the recordability of compound muscle action potentials (CMAP) following single transcranial magnetic stimulation of the motor cortex (sTCMS). Repetition of the magnetic stimulus (repetitive transcranial magnetic stimulation, rTCMS) might allow the inhibition caused by anaesthesia with isoflurane or propofol to be overcome. ⋯ In most patients, rTCMS can overcome suppression of CMAP during propofol/nitrous oxide anaesthesia, but not during isoflurane anaesthesia. A train of four magnetic stimuli at a frequency of 333 Hz is most effective in evoking potentials from the upper and lower limb muscles. The authors conclude that rTCMS can be used for evaluation of the descending motor pathways during anaesthesia.
-
Cardiac preconditioning represents the most potent and consistently reproducible method of rescuing heart tissue from undergoing irreversible ischaemic damage. Major milestones regarding the elucidation of this phenomenon have been passed in the last two decades. The signalling and amplification cascades from the preconditioning stimulus, be it ischaemic or pharmacological, to the putative end-effectors, including the mechanisms involved in cellular protection, are discussed in this review. ⋯ Similarly, opioids activate delta- and kappa-opioid receptors, and this also leads to PKC activation. Activated PKC acts as an amplifier of the preconditioning stimulus and stabilizes, by phosphorylation, the open state of the mitochondrial K(ATP) channel (the main end-effector in anaesthetic preconditioning) and the sarcolemmal K(ATP) channel. The opening of K(ATP) channels ultimately elicits cytoprotection by decreasing cytosolic and mitochondrial Ca(2+) overload.
-
Randomized Controlled Trial Clinical Trial
Comparison of three different volumes of mepivacaine in axillary plexus block using multiple nerve stimulation.
The multiple injection technique for axillary block, in which the four distal nerves of the plexus are located by a nerve stimulator and separately injected, has been shown to provide a high success rate and a short onset time. This randomized double-blind study was conducted to compare the effectiveness of three different volumes of mepivacaine 10 mg x ml(-1) in patients undergoing elective distal upper limb surgery under axillary brachial plexus block with the four-nerve approach. The number of complete sensory blocks was the primary efficacy variable. ⋯ The three volumes (38, 28, and 20 ml) of mepivacaine 10 mg x ml(-1) ensured a similar and high percentage of complete sensory blocks in axillary brachial plexus anaesthesia with nerve stimulation involving the location of four motor responses.
-
Randomized Controlled Trial Clinical Trial
Randomized trial of novel tetracaine patch to provide local anaesthesia in neonates undergoing venepuncture.
Procedures such as venepuncture or heel prick are painful and may cause considerable stress to newborn infants. Topical local anaesthetics are effective for venepuncture but need to be applied for at least 60 min and the delivered dose will vary. We assessed a novel tetracaine-based self-adhesive patch in providing controlled local anaesthesia before venepuncture. ⋯ The tetracaine patch produced effective pain relief during the venepuncture procedure in both term and pre-term infants. There were no adverse effects, either local or systemic.