British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of phenylephrine infusion regimens for maintaining maternal blood pressure during spinal anaesthesia for Caesarean section.
During spinal anaesthesia for Caesarean section, the optimal phenylephrine regimen and the optimal blood pressure (BP) to which it should be titrated are undetermined. The ideal regimen would balance efficacy for maintaining uteroplacental perfusion pressure against potential for uteroplacental vasoconstriction, both of which may affect fetal acid-base status. We compared phenylephrine infusion regimens based on three different BP thresholds. ⋯ For optimal management, phenylephrine should be titrated to maintain maternal BP at near-baseline values.
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Clinical Trial Controlled Clinical Trial
Pharmacokinetics of remifentanil and its major metabolite, remifentanil acid, in ICU patients with renal impairment.
The pharmacokinetics of remifentanil, an opioid analgesic metabolized by non-specific esterases, and its principal metabolite, remifentanil acid (RA), which is excreted via the kidneys, were assessed as part of an open-label safety study in intensive care unit (ICU) patients with varying degrees of renal impairment. ⋯ Although RA accumulates in patients with moderate/severe renal impairment, pharmacokinetic modelling predicts that RA concentrations during a 9 microg kg(-1) h(-1) remifentanil infusion for up to 15 days would not exceed those reported in the present study, for which no associated prolongation of mu-opioid effects was observed.
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Sore throat and hoarseness are common complications, but these have not been studied after total i.v. anaesthesia. ⋯ Knowledge of these factors may reduce postoperative throat complications, and improve patient satisfaction.