Articles: anesthetics.
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Randomized Controlled Trial Clinical Trial
A lignocaine-prilocaine cream reduces venipuncture pain.
A new, topical anaesthetic formulation, EMLA 5% cream (Eutectic Mixture of Local Anaesthetics), and placebo have been compared in a randomized double-blind study of 51 children. The objectives were to test if EMLA diminishes pain from venipuncture, to evaluate possible adverse reactions, and to determine if there is any influence upon the ease with which the insertion procedure is carried out. Pain was evaluated using a three-graded verbal rating scale. ⋯ No oedema occurred, but a few cases of local redness and paleness were observed after EMLA treatment. However, these reactions were clinically insignificant. It is concluded that EMLA significantly reduces pain from venipuncture, and side effects are mild and transient.
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Randomized Controlled Trial Comparative Study Clinical Trial
[The significance of tramadol as an intraoperative analgesic. A randomized double-blind study in comparison with placebo].
Tramadol-N2O anaesthesia as recommended by Stoffregen was studied in 40 patients (ASA I-II) undergoing elective orthopaedic or lower abdominal surgery. Fentanyl and droperidol (Thalamonal)/atropine were given as i.m. premedication, induction was performed using methohexitone, succinylcholine and pancuronium, ventilation was controlled by means of a Takaoka respirator (N2O/O2 79:21, 4 breaths/min). Intraoperative analgesia was provided by a biphasic tramadol infusion. ⋯ When enflurane had not been necessary (tramadol n = 13, placebo n = 10), mean percentage rises of blood pressure or pulse rate, related to preoperative values, were found to be slightly higher in the tramadol group. Postoperative analgesic requirement was reduced significantly after tramadol. Striking differences between the two groups, on the other hand, were shown with respect to intraoperative awareness: while patients receiving placebo proved to be amnaesic, 65% of tramadol patients were aware of intraoperative music.(ABSTRACT TRUNCATED AT 250 WORDS)
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Dispersed guinea-pig adrenal cells or mouse Leydig cells were stimulated with a saturating dose of adrenocorticotrophin (ACTH, 50 ng/1) or luteinizing hormone (LH, 5IU/1), respectively. The incubations were performed in the presence of increasing concentrations (10(-9) - 5 X 10(-4)mol/l) of the anaesthetic agents propofol, thiopentone and etomidate. At the end of this stimulation period, cortisol (from the adrenal preparation) or testosterone (from the Leydig cell culture) were assayed by radioimmunoassay. ⋯ All the stimulators increased cortisol production by > 7-fold over that seen in their absence. Propofol depressed ACTH and dibutyryl cAMP induced cortisol output by > 60% (P < 0.05) but was without effect when the steroid precursors were used, suggestive of an inhibition between the sequence involving ACTH binding -> pregnenolone production. In contrast, etomidate and thiopentone reduced cortisol secretion by > 40% (P < 0.05) regardless of the stimulator used, indicating that at least one site of action was at the level of the final enzymic step of cortisol synthesis, i.e. 11beta-hydroxylase.
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The authors demonstrated that soda lime will adsorb enflurane or isoflurane as a function of the water content of the soda lime. Various volumes of liquid enflurane or isoflurane were placed in an equilibration flask containing fresh (15% water by weight) or dried soda lime and the vapor phase anesthetic concentrations plotted. ⋯ This is qualitatively similar to data reported previously for halothane. The authors hypothesize that drying soda lime produces a molecular sieve-like structure, as adsorption is greatest for molecules with small carbon chain lengths and kinetic diameters, or with structural characteristics such as cis/trans isomerism, which effectively reduce molecular size.