British journal of anaesthesia
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Randomized Controlled Trial Multicenter Study
Morphine pharmacokinetics and pharmacodynamics in preterm and term neonates: secondary results from the NEOPAIN trial.
Relationships between plasma morphine concentrations and neonatal responses to endotracheal tube (ETT) suctioning are unknown in preterm neonates. ⋯ A sigmoid curve describing maturation of morphine clearance is moved to the right in preterm neonates and volume of distribution is increased compared with term neonates. Morphine does not alter the neonatal response to ETT suctioning.
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Randomized Controlled Trial Comparative Study
Spinal anaesthesia for elective surgery: a comparison of hyperbaric solutions of racemic bupivacaine, levobupivacaine, and ropivacaine.
The aim of this study was to compare the clinical effects of 'hyperbaric' bupivacaine for spinal anaesthesia with those of similar preparations of levobupivacaine and ropivacaine. ⋯ 'Hyperbaric' ropivacaine provides reliable spinal anaesthesia of shorter duration than bupivacaine or levobupivacaine, both of which are clinically indistinguishable. The recovery profile of ropivacaine may be useful where prompt mobilization is required.
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Randomized Controlled Trial Comparative Study
Effect of propofol and sevoflurane on coughing in smokers and non-smokers awakening from general anaesthesia at the end of a cervical spine surgery.
Coughing during emergence from general anaesthesia may be detrimental, particularly after cervical spine surgery. We compared the effect of propofol or sevoflurane anaesthesia on the incidence and severity of coughing during recovery in patients undergoing cervical spine surgery via an anterior approach. As a secondary aim, we also evaluated the influences of smoking and estimated residual anaesthetic agent concentrations on coughing. ⋯ The incidence of coughing after cervical spine surgery when tracheal extubation is performed according to clinical criteria is lower after propofol anaesthesia compared with sevoflurane anaesthesia. Smokers are at increased risk of coughing, independently of the type of anaesthesia maintenance. Higher residual concentrations of anaesthetic agents decrease the probability of coughing, except for smokers anaesthetized with sevoflurane.
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Randomized Controlled Trial
Prophylactic mirtazapine reduces intrathecal morphine-induced pruritus.
Activation of the serotonergic system is an important factor in the pathogenesis of intrathecal morphine-induced pruritus. Mirtazapine is a new antidepressant that selectively blocks 5-HT(2) and 5-HT(3) receptors. We therefore tested the hypothesis that preoperative mirtazapine would reduce the incidence of intrathecal morphine-induced pruritus. ⋯ Mirtazapine premedication prevents pruritus induced by intrathecal morphine in patients undergoing lower limb surgery with spinal anaesthesia.
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Randomized Controlled Trial
Pre-incisional epidural magnesium provides pre-emptive and preventive analgesia in patients undergoing abdominal hysterectomy.
This prospective, randomized, double-blind study was designed to evaluate the preemptive and preventive analgesic efficacy of adding magnesium to a multimodal regimen of patient-controlled epidural analgesia (PCEA) in patients undergoing abdominal hysterectomy. ⋯ Continuous epidural magnesium started before anaesthesia provided preemptive, preventive analgesia, and an analgesic-sparing effect that improved postoperative analgesia without increasing the incidence of side-effects.