British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Postoperative glucose tolerance during extradural analgesia.
Thirteen patients undergoing lower abdominal gynaecological surgery were allocated to general anaesthesia (halothane and nitrous oxide) or general anaesthesia plus extradural analgesia (T8-S5). I.v. glucose tolerance tests were performed on the day before surgery and 8 h after skin incision. ⋯ Extradural analgesia blocked the hyperglycaemic response to surgery but not the late postoperative cortisol response, although values were significantly less than in the group receiving general anaesthesia alone. Impairment of glucose tolerance and of insulin response to the glucose load in the period after operation were not influenced by extradural analgesia and this may have resulted from insufficient inhibition of the stress-induced release of catecholamines or cortisol, or both, or from blockade of stimulatory efferent sympathetic pathways to pancreatic islets.
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Comparative Study
Alfentanil: a study of its analgesic activity and interactions with morphine in the mouse.
Alfentanil has a short duration action which did not markedly increase with increasing dose in mice. It is approximately one-fourth as potent as fentanyl. ⋯ This has been demonstrated with injection of alfentanil 15 min before, simultaneously with and 30 min after morphine injection. There were not significant effects on depression of respiratory rate produce by morphine.
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Neuromuscular transmission was measured using train-of-four stimulation, during and after anaesthesia, in 20 patients with end-stage renal failure. Neuromuscular blockade was provided with pancuronium in single doses of either 3 or 6 mg per 70 kg, and antagonized at 10% recovery with atropine and neostigmine 2.5 mg per 70 kg. ⋯ It is concluded that, when pancuronium is antagonized with neostigmine in patients with renal failure, neuromuscular transmission recovers without evidence of recurarization. However, when large doses of pancuronium are antagonized with neostigmine 2.5 mg, recovery may be insufficient to ensure normal ventilatory function.