Journal of the Medical Association of Thailand = Chotmaihet thangphaet
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of different doses of epidural morphine for pain relief following cesarean section.
Although epidural opioid analgesia after cesarean section can provide excellent postoperative pain relief, serious complications may occur after epidural morphine. Therefore, we performed this study to compare the efficacy and side effects of three different doses of epidural morphine for analgesia following cesarean section. Ninety healthy pregnant women who underwent cesarean delivery were randomly assigned to receive either 2.5, 3 or 4 mg of epidural morphine for postoperative analgesia. ⋯ Mild pruritus and nausea occurred in all three groups and there was no significant difference between them. No serious complications were observed. In conclusion low dose epidural morphine is effective in providing adequate analgesia following cesarean delivery.
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Randomized Controlled Trial Clinical Trial
Tranexamic acid as a means of reducing the need for blood and blood component therapy in children undergoing open heart surgery for congenital cyanotic heart disease.
Children undergoing cardiac operations using cardiopulmonary bypass (CPB) are at risk of significant postoperative bleeding and the need for transfusion. The antifibrinolytic drug, tranexamic acid, decreases blood loss in adult patients undergoing cardiac surgery. However, its efficacy has not been extensively studied in patients with cyanotic congenital heart defects (CHD). ⋯ Also there was no significant difference in the amounts of blood and blood products administered between the two groups. No adverse effects of tranexamic acid were found in this study. In conclusion, there was no significant difference in postoperative blood loss or blood and blood product requirement between those children with cyanotic CHD undergoing open heart surgery who received a single dose of tranexamic acid compared with those who received two doses.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of sufentanil and fentanyl for surgical repair of congenital cardiac defects.
In the present study, the authors compared sufentanil to fentanyl in pediatric patients undergoing congenital cardiac repair. The purpose of the study was to evaluate the hemodynamic variables, time of awakening and successful extubation of the two groups. A prospective, randomized study of 60 children scheduled for elective surgery of congenital cardiac defects was made. ⋯ There were no significant differences in times of awakening in the two groups. The patients in sufentanyl group had a longer time to extubate than the fentanyl group. The need of postoperative sedation and analgesia was the same in both groups.
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Randomized Controlled Trial Clinical Trial
Postoperative analgesic effects of intravenous lornoxicam and morphine with pre-emtive ropivacaine skin infiltration and preperitoneal instillation after transabdominal hysterectomy.
To investigate the effectiveness of intravenous lornoxicam and morphine with the preemptive effects of ropivacaine local skin infiltration and peritoneal instillation in reducing postoperative pain after transabdominal hysterectomy, a randomized, double blinded, placebo-controlled study was done in 88 patients undergoing transabdominal hysterectomy under general anesthesia. The patients were allocated into 4 groups to receive: (group A) only intravenous morphine 10 mg; (group B) intravenous morphine 10 mg and lornoxicam 16 mg; (group C) intravenous morphine 10 mg, lornoxicam 16 mg with 0.5 per cent ropivacaine local skin infiltration before skin incision and 1 per cent ropivacaine instillation before peritoneal incision; (group D) intravenous morphine 10 mg, lornoxicam 16 mg with 1 per cent ropivacaine instillation after peritoneal closure and 0.5 per cent ropivacaine local skin infiltration before skin closure. Pain was assessed by patients using visual analog scales (VAS) at 2, 6, 12, 18, 24, 48 hours after surgery. Time to first analgesic requirement and morphine requirement during the first 6 h were significantly lower in the groups using lornoxicam (group B, C, D) as compared with the group using only morphine (group A). However there was no significant difference between group B and group C or group D which means that the additional analgesic effects of using local anesthetic infiltration and instillation either before (pre-emptive) or after the incision could not be seen in this study. ⋯ Intravenous 16 mg of lornoxicam with 10 mg of morphine significantly reduced postoperative pain during the first 6 h after abdominal hysterectomy. Additional effects of using local anesthetic wound infiltration to the use of lornoxicam could not be demonstrated.
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Transillumination of the soft tissue of the neck using a lighted stylet (lightwand) is an effective and safe intubating technique in experienced hands. The goal of this study was to determine the effectiveness and safety of this device in intubating the trachea of elective surgical patients by non-experienced hands. One hundred and fifty, paralysed, anesthetized, adult patients (ASA I-II, no known or potential problems with intubation) were studied. ⋯ There were significantly fewer traumatic events (5.33%). Most of the trauma consisted of minor mucosal bleeding or mucosal laceration. We conclude that lightwand intubation is an effective and safe technique in non-experienced hands.