British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of hyperbaric and plain ropivacaine 15 mg in spinal anaesthesia for lower limb surgery.
Previously, plain ropivacaine 15 mg given intrathecally has been shown to be feasible for ambulatory surgery of lower-extremities. Hypothetically, hyperbaric solution could improve and shorten the block. ⋯ In comparison with the plain solution, 15 mg of intrathecal hyperbaric ropivacaine produced a faster onset, greater success rate of analgesia at the level of T(10) dermatome, and faster recovery of the block.
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Randomized Controlled Trial Comparative Study Clinical Trial
Spectral entropy measurement of patient responsiveness during propofol and remifentanil. A comparison with the bispectral index.
We compared two spectral entropies, state entropy (SE) and response entropy (RE), based on the irregularity of the EEG, to measure loss of response to verbal command (LOR(verbal)) and noxious stimulus (LOR(noxious)) with the bispectral index (BIS) during propofol infusion with and without remifentanil. ⋯ LOR(verbal) was detected accurately by BIS, SE and RE except for 100% sensitivity, where BIS performed better. Though BIS, SE and RE were influenced by remifentanil during propofol administration, their ability to detect LOR(verbal) remained accurate. None of the measures predicted LOR(noxious).
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Efforts to develop new hypnotic compounds continue, although several have recently failed in development. Propofol has been reformulated in various presentations with and without preservatives. Pharmacokinetic and pharmacodynamic differences exist between some of these preparations, and it is currently unclear whether any have substantial advantages over the original presentation. ⋯ Linking of electroencephalogram (EEG) monitoring to TCI for closed-loop anaesthesia remains a research tool, although commercial development may follow. The availability of stereoisomer ketamine and improved understanding of its pharmacology have increased non-anaesthetic use of ketamine as an adjunct analgesic. It may be useful in subhypnotic doses for postsurgical patients with pain refractory to morphine administration.
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Randomized Controlled Trial Clinical Trial
Target concentrations of remifentanil with propofol to blunt coughing during intubation, cuff inflation, and tracheal suctioning.
The target blood concentrations of propofol and remifentanil, when used in combination, required to blunt the cough response to tracheal intubation, cuff inflation, and tracheal suctioning without neuromuscular blocking agents are not known. ⋯ Target remifentanil blood concentrations of 5, 10, and 15 ng ml(-1) associated with a 3.5 microg ml(-1) propofol target blood concentration provided good intubating conditions and absence of cough about 75% of the time. Higher target remifentanil concentrations were associated with less coughing during tracheal tube cuff inflation and tracheal suctioning.