British journal of anaesthesia
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Patients with drug allergies are commonplace in anaesthetic practice. We investigated the incidence and nature of drug 'allergies' reported by surgical patients attending a hospital pre-admission clinic, and went on to ascertain to what degree drug allergies recorded in the records influenced drug prescribing during the patients' hospital stay and determine whether any adverse events occurred in relation to drug prescribing in this population. ⋯ The majority of the self-reported allergies were in fact simply accepted adverse effects of the drugs concerned. The patients' reported drug 'allergy' history was generally well respected by anaesthetists and other medical staff. There were 13 incidents, mainly involving morphine, where patients were given a drug to which they had claimed a specific allergy. There were 101 incidents in 89 patients where drugs of the same pharmacological group as that of their allergic drug were used. There were no untoward reactions in 84 patients who had claimed a prior adverse reaction to penicillin who were given cephalosporins. There were no sequelae from any other events. While anaesthetists generally respected patients self-reported 'allergies', more attention needs to be paid to the accurate recording of patients' events and a clear distinction should be made both in medical records and to the patient between true drug allergy and simple adverse drug reactions.
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Randomized Controlled Trial Comparative Study
Inspired oxygen fraction of 0.8 compared with 0.4 does not further reduce postoperative nausea and vomiting in dolasetron-treated patients undergoing laparoscopic cholecystectomy.
Postoperative nausea and vomiting (PONV) is one of the most frequent complications after general anaesthesia. Single-dose antiemetic prophylaxis has limited efficacy in high-risk patients. Adding a simple potential antiemetic approach, such as increasing the inspired oxygen fraction, to the antiemetic portfolio would preserve pharmacological interventions for treatment of symptoms in the postoperative period. However, the antiemetic effect of a high inspired oxygen fraction is still discussed controversially. The aim of the study was to evaluate whether an inspired oxygen fraction of 0.8 decreases PONV in patients receiving the 5-HT3-antagonist dolasetron. ⋯ An inspired oxygen fraction of 0.8 does not further decrease PONV or vomiting in dolasetron-treated patients undergoing laparoscopic cholecystectomy. The lower incidence of PONV in Groups A and B compared with Group C is most likely caused by the omission of nitrous oxide.
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Randomized Controlled Trial
Dexmedetomidine as an anaesthetic adjuvant in patients undergoing intracranial tumour surgery: a double-blind, randomized and placebo-controlled study.
Dexmedetomidine (DEX) has been shown to provide good perioperative haemodynamic stability with decreased intraoperative opioid requirements. It may have neural protective effects, and thus may be a suitable anaesthetic adjuvant to neurosurgical anaesthesia. ⋯ DEX increased perioperative haemodynamic stability in patients undergoing brain tumour surgery. Compared with fentanyl, the trachea was extubated [corrected] faster without respiratory depression.
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Despite the use of various treatment strategies arthroscopic knee surgery is still associated with clinically important postoperative pain. As the infrapatellar nerve (IPN) innervates vital anterior knee structures we decided to investigate the feasibility of a novel ultrasound-guided IPN block technique as a potential therapeutic option for out-patient arthroscopic knee surgery. ⋯ Reliable blockade of the IPN can be achieved with ultrasonographic guidance. Because of the very close anatomical relationship between the IPN and the SN it appears inevitable to also get a variable degree of concomitant SN block. The duration of the IPN block was in the majority of subjects greater than 16 h, a finding that may make this block useful for postoperative analgesia in out-patient arthroscopic surgery.
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Randomized Controlled Trial Comparative Study
Comparison of the effects of thoracic epidural analgesia and i.v. infusion with lidocaine on cytokine response, postoperative pain and bowel function in patients undergoing colonic surgery.
Both thoracic epidural analgesia (TEA) and i.v. lidocaine were able to decrease postoperative pain and duration of ileus. We compared TEA and i.v. lidocaine (IV) regarding their effects on cytokines, pain and bowel function after colonic surgery. ⋯ The TEA lidocaine had better pain relief, lower opioid consumption, earlier return of bowel function and lesser production of cytokines than IV lidocaine during 72 h after colonic surgery; IV group was better than the control group.