British journal of anaesthesia
-
Randomized Controlled Trial Clinical Trial
Influence of neostigmine on postoperative vomiting.
Thirty-eight patients undergoing elective hip or knee surgery were randomly allocated to two groups. Neuromuscular blockade in group A was antagonized with neostigmine 2.5 mg and atropine 1.2 mg, while group B received no drugs to facilitate antagonism of blockade. The incidence and severity of postoperative nausea and vomiting were assessed 24 h after operation. ⋯ The incidence of nausea in group A was 68%, compared with 32% in group B (P less than 0.01). The incidence of vomiting was 47% in group A, compared with 11% in group B (P less than 0.02). A significant relationship was shown between postoperative emetic symptoms and the antagonism of neuromuscular blockade by neostigmine and atropine.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of chloral hydrate and midazolam by mouth as premedicants in children undergoing otolaryngological surgery.
Chloral hydrate 25, 50 or 75 mg kg-1 or midazolam 0.4, 0.5 or 0.6 mg kg-1, all given by mouth in combination with atropine 0.03 mg kg-1, were compared as premedication in 248 children in a randomized, double-blind study. Chloral hydrate was significantly less palatable than midazolam. The anxiolytic effect of chloral hydrate 75 mg kg-1 was "good" in children younger than 5 yr, whereas the other doses of chloral hydrate, and all doses of midazolam, provided only "fair" anxiolysis in this age group. ⋯ The mean total recovery score (0-10) based on activity, ventilation, heart rate, conscious level and colour ranged between 5.8 and 6.8 at 10 min and between 9 and 9.5 at 70 min after extubation in all groups. Midazolam 0.5 mg kg-1 is recommended for children less than 5 yr of age and midazolam 0.4-0.5 mg kg-1 for older ones. Chloral hydrate 75 mg kg-1 provided good anxiolysis in both age groups; however, it was less palatable than the midazolam.
-
Twenty-two anaesthetists participated in a study to assess the influence of occupational exposure to anaesthetic agents on mood (arousal and stress) and cognitive functions. In a cross-over design, each anaesthetist worked one day in a reference facility (for example, intensive care) and another day in a scavenged operating theatre where time-weighted exposure averaged nitrous oxide 58 p.p.m. and halothane 1.4 p.p.m. The results showed that arousal scores reached a peak in the middle of the theatre day, but this appeared to reflect the nature of operating theatre work rather than exposure. ⋯ Similarly, there was no evidence that exposure impaired performance of tasks assessing syntactic and semantic reasoning, verbal and spatial memory, sensory-motor reaction time and attention. Performance in these tasks was, however, sensitive to the cognitive demands of the tasks and to naturally varying non-exposure factors. It is concluded that, compared with the reference condition, the concentrations of anaesthetic agents found in actively scavenged operating theatres have no detrimental effect on either the mood or the cognitive functions of anaesthetists.
-
Comparative Study
Comparison of the adductor pollicis and the first dorsal interosseous muscles during atracurium and vecuronium blockade: an electromyographic study.
The pattern of neuromuscular blockade in the first dorsal interosseous muscle (1st DI) and the adductor pollicis muscle was compared electromyographically following atracurium or vecuronium. There were no clinically significant differences between the muscles in respect of onset time, maximum blockade, train-of-four ratio, or recovery index. There were no problems in recording a consistent electromyogram from the 1st DI, which appears to be well suited to clinical monitoring.
-
The effects of methohexitone, ketamine, Althesin and droperidol on the peripheral vagal transmission to the heart were studied in decerebrate cats by evaluating the influences of the drugs on the heart rate responses to vagal electrostimulation and the injection of acetylcholine i.v. The sites of the peripheral vagal transmission (vagal ganglia and sino-atrial pacemaker cells) were reached by the application of the drugs to the pericardial space. The bradycardia in response to vagal electrostimulation was attenuated by Althesin (2.1 x 10(-4)-3.3 x 10(-3) mol litre-1; expressed as the concentration of alphaxalone), ketamine (2.9 x 10(-4)-4.6 x 10(-3) mol litre-1) and droperidol (2.6 x 10(-5)-6.6 x 10(-4) mol litre-1) in a concentration-dependent manner, but not influenced by methohexitone (2.8 x 10(-4)-4.4 x 10(-3) mol litre-1). The bradycardia-attenuating effects were probably caused by an atropine-like action since the heart rate responses to the injection of acetylcholine i.v. were also attenuated by the same three drugs.