Canadian Anaesthetists' Society journal
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Randomized Controlled Trial Comparative Study Clinical Trial
Left ventricular ejection fraction during anaesthetic induction: comparison of rapid-sequence and elective induction.
A randomized clinical trial was conducted in 14 women, aged 24-60 years, to compare the effects of rapid-sequence induction of anaesthesia and elective induction on heart rate, blood pressure and left ventricular ejection fraction (LVEF). None of the patients suffered from heart or lung diseases, and all were scheduled for hysterectomy. Cuff blood pressure was measured repeatedly by an automatic recording device, and heart rate and LVEF were monitored by a portable nonimaging nuclear probe. ⋯ Similar decreases in LVEF was observed in both groups, from 0.60 to 0.42 in the elective induction group, and from 0.60 to 0.41 in the rapid-sequence induction group. The equal depression of LVEF indicates that laryngoscopy and intubation produce, with both induction regimens, sudden impairment of cardiac function. The more pronounced hypertension and tachycardia observed during rapid-sequence induction suggests a higher myocardial oxygen consumption which may represent a serious additional burden for the poorly perfused heart.
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Randomized Controlled Trial Clinical Trial
Cardiovascular effects of non-depolarizing neuromuscular blockers in patients with coronary artery disease.
To compare haemodynamic responses associated with equipotent doses of muscle relaxants and high dose fentanyl (50 micrograms X kg-1), 40 non-hypertensive patients who were receiving beta adrenergic and calcium channel blocker therapy and undergoing coronary bypass surgery were randomized to four study groups receiving the following: (1) atracurium: 0.4 mg X kg-1, (2) pancuronium: 0.12 mg X kg-1, (3) vecuronium: 0.12 mg X kg-1, or (4) pancuronium-metocurine mixture: (0.4 mg + 1.6 mg X ml-1):1 ml/10 kg. Neuromuscular blockers were injected with fetanyl at induction. Haemodynamics were recorded with the patients awake (baseline), at two minutes post-induction, and at two and five minutes after intubation. ⋯ The pancuronium-metocurine mixture caused tachycardia which was less than, though not significantly different than with pancuronium; however, HR returned to baseline by five minutes with the mixture, but remained elevated with pancuronium (3 vs. 18 per cent, p less than 0.05). SVR fell more on induction with atracurium when compared to vecuronium (-18 vs. 1 per cent, p less than 0.05). These changes in HR or SVR were not accompanied by ECG signs of ischaemia.(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Clinical Trial
Nausea and vomiting after strabismus surgery in preschool children.
The incidence of nausea and vomiting after strabismus surgery was studied in 64 children aged one to six years. Incidence was determined in the post-anaesthesia recovery room (PARR), in the same day surgery (SDS) unit, and at home on days one and two after the operation. ⋯ Droperidol slightly but significantly delayed awakening and was not, at least in this particular age group, associated with any difference in postoperative sickness. Despite theoretical advantages, glycopyrrolate offered no significant benefit over atropine as far as postoperative emesis was concerned.
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Randomized Controlled Trial Clinical Trial
Epidural ketamine for postoperative analgesia.
Thirty-four patients of ASA physical status I or II scheduled for gall bladder surgery were studied in a comparative prospective trial to evaluate the efficacy of epidural and intramuscular ketamine for postoperative pain relief. They were divided randomly into three groups. Group I (11 patients) received 30 mg intramuscular ketamine. ⋯ Four patients who received epidural ketamine complained of transient burning pain in the back during injection. No patient developed respiratory depression, psychic disturbance, cardiovascular instability, bladder dysfunction or neurologic deficit. It is concluded that 30 mg epidural ketamine is a safe and effective method for postoperative analgesia.
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Randomized Controlled Trial Clinical Trial
Fentanyl-oxygen versus fentanyl-N2O/oxygen anaesthesia in children undergoing cardiac surgery.
Fentanyl-oxygen (fentanyl-O2) anaesthesia was compared to fentanyl-nitrous oxide/oxygen (fentanyl-N2O/O2) anaesthesia in 14 children undergoing cardiac surgery. Children were randomly assigned to one of the two techniques studied, with seven patients in each group. The mean age (mean +/- SE) was 3.9 +/- 0.75 years (0.5-8.25 years) and mean weight 14.7 +/- 2 kg (3.5-29.5 kg). ⋯ Similar phenomena were not documented in the fentanyl-N2O/O2 group. Our studies suggest that fentanyl-O2 anaesthesia in the schedule described, in children undergoing elective cardiac surgery for Tetralogy of Fallot, A-V canal, and transposition of the great arteries, is not sufficient to prevent elevation in systolic blood pressure despite fentanyl plasma concentrations in excess of 20 ng X ml-1. The addition of nitrous oxide prevents this phenomenon.