British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Epidural test dose with levobupivacaine and ropivacaine: determination of ED(50) motor block after spinal administration.
When a test is required to detect a possible intrathecal catheter, many would seek to use the same local anaesthetic as that used for epidural analgesia. The rapid onset of inappropriate motor block after a local anaesthetic administered epidurally implies intrathecal spread. Because of claims of greater sensory-motor separation, or because of reduced potency compared with bupivacaine, the efficacy of the new local anaesthetics in intrathecal testing has been questioned. The aim of this study was to establish the feasibility of a test dose for an inadvertent intrathecal catheter using ropivacaine and levobupivacaine, and to establish the dose required. ⋯ Both local anaesthetics produce evidence of motor block within 5 min of intrathecal injection and could serve as tests of intrathecal administration. Derived ED(95) values suggest 10 mg doses should be effective, but this study did not measure predictive value. Ropivacaine is less potent for motor block than levobupivacaine by a factor of 0.83 (P<0.04).
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Randomized Controlled Trial Comparative Study Clinical Trial
Early analgesic effects of parecoxib versus ketorolac following laparoscopic sterilization: a randomized controlled trial.
The aim of this prospective double blind randomized controlled trial was to compare the effects of ketorolac and parecoxib on early postoperative pain. ⋯ We found that parecoxib 40 mg i.v. given at induction of anaesthesia was less effective than or ketorolac 30 mg i.v., in the first hour after laparoscopic sterilization.
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Review Randomized Controlled Trial Clinical Trial
NICE guidelines for central venous catheterization in children. Is the evidence base sufficient?
Recent guidelines from the National Institute for Clinical Excellence (NICE) recommend the use of ultrasound guidance for central venous catheterization in children. This study prospectively examined the use of ultrasound guidance for central venous catheterization in children undergoing heart surgery. ⋯ These results are different from the published results on which the NICE guidelines were based; however, the evidence base in children is small. There is currently insufficient evidence to support the use of ultrasound guidance for central venous catheterization in children.
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Randomized Controlled Trial Clinical Trial
Cardiovascular changes with the laryngeal mask airway in cardiac anaesthesia.
The laryngeal mask airway (LMA) causes fewer haemodynamic changes, particularly in mean arterial pressure (MAP) and heart rate (HR), than tracheal intubation using either laryngoscopy or the intubating LMA. There are no data for patients with coronary artery disease. ⋯ The LMA allows airway management without hypertension and tachycardia and should be considered when anaesthetizing patients with coronary disease.
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Randomized Controlled Trial Clinical Trial
Drug patient information leaflets in anaesthesia: effect on anxiety and patient satisfaction.
Patient information leaflets are produced for all new drugs, including anaesthetic drugs that are licensed solely for physician administration. The effect of this information on patients' satisfaction and anxiety has not been investigated previously. ⋯ A minority of patients (up to 36%) wish to receive detailed anaesthetic drug information before anaesthesia. Manufacturers' drug patient information leaflets do not alter preoperative anxiety and may be safely issued to patients requesting such information.