British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Zomepirac, dihydrocodeine and placebo compared in postoperative pain after day-case surgery. The relationship between the effects of single and multiple doses.
Zomepirac 100 mg and dihydrocodeine 30 mg were compared with placebo in a controlled randomized, double-blind, single-dose postoperative study. Patients continued to receive either zomepirac or dihydrocodeine for pain relief for 5 days at home in a double-blind study, being allowed to titrate the consumption of tablets to their degree of pain. ⋯ In the multiple dosing phase, zomepirac was statistically better than dihydrocodeine. Non-parametric statistical tests indicated highly significant correlations between single- and multiple-dose analgesic measurements for both zomepirac and dihydrocodeine.
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Jet ventilation, through a bronchoscope, was evaluated using a lung model (normal compliance and increased airway resistance). Three I/E ratios (0.25, 0.43, 0.67) and seven rates of ventilation (from 20 to 230 cycles per min (c min-1) were studied with the bronchoscope either unoccluded or partially occluded by a telescope. ⋯ The introduction of the telescope reduced minute ventilation, as a result of a decrease in the amount of air entrained, and increased end-expiratory pressure and lung volume. The risk of barotrauma as a result of high peak pressure is reduced during high frequency jet ventilation, but the increase in lung volume, particularly when the telescope is introduced, may be of clinical importance.
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Comparative Study
Effect of intrathecal diamorphine on the adrenocortical, hyperglycaemic and cardiovascular responses to major colonic surgery.
The effect of the intrathecal administration of diamorphine on the hyperglycaemic, adrenocortical and cardiovascular responses to major colonic surgery were investigated, and the results compared with those obtained in a similar group of patients receiving low doses of fentanyl. In the group receiving intrathecal diamorphine, the hyperglycaemic response was delayed, and the adrenocortical response decreased significantly both during and following surgery; there were no significant cardiovascular responses to incision, and analgesia was prolonged after operation.
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Neurotoxicity after subarachnoid infusion of bupivacaine, lignocaine and 2-chloroprocaine was studied in a chronic rat model. Hartmann's solution 100 microliter h-1 was infused as a control, and 0.5% bupivacaine, 1.5% lignocaine and 2.0% 2-chloroprocaine were infused at 100 microliter h-1 for 3, 6 or 24 h, to five rats in each group. ⋯ Abnormal histology, in the form of neuronal vacuolation, was not a sensitive index, being present in control rats, but more intense in those receiving lignocaine and 2-chloroprocaine than in those given bupivacaine; no correlation with clinical findings could be established. The neurotoxic effects of each local anaesthetic tested as a continuous intrathecal infusion were dose related in the rat, which may be a useful model for screening other local anaesthetics.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of midazolam, diazepam and placebo i.m. as premedication for regional anaesthesia. A randomized double-blind study.
In a randomized double-blind study, midazolam 0.1 mg kg-1 i.m. was compared with diazepam 0.2 mg kg-1 and placebo as premedication for patients undergoing urological interventions under spinal anaesthesia. The sedative and anxiolytic effects of midazolam were evident 5-10 min after administration, and were maximum between 30 and 90 min. ⋯ Amnesia was not seen in the patients receiving diazepam or placebo and, in contrast to midazolam, diazepam had almost no sleep-inducing effect. In a few patients, the depth of sleep achieved with midazolam 0.1 mg kg-1 was such that co-operation was impaired.