Postgraduate medical journal
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of intravenous and subcutaneous hydration in elderly acute stroke patients.
The aim of this study was to compare the effectiveness of subcutaneous and intravenous fluid therapy in hydrating, elderly acute stroke patients. Thirty-four such patients, needing parenteral fluids because of impaired consciousness or dysphagia, were randomly allocated to receive either subcutaneous or intravenous fluids (2 litres of dextrose-saline/24 hours). Serum osmolality was measured before starting fluid therapy (Day 1) and on Days 2 and 3. ⋯ The total cost of cannulae used over the 3 days for the subcutaneous route was approximately a third of that for the intravenous route. Complication rates were similar for the two groups. The results suggest that subcutaneous fluid therapy is an effective alternative to the intravenous route.
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Randomized Controlled Trial Clinical Trial
The effect of different nitrate preparations on plasma heparin concentrations and the activated partial thromboplastin time.
There is evidence that intravenous nitrates which are frequently used in acute coronary syndromes may interfere with the anticoagulant effect of heparin. We compared the effect of two different nitrate preparations on the activated partial thromboplastin time (APTT), anti-thrombin III activity (AT III) and plasma heparin levels in patients (n = 50) undergoing routine percutaneous transluminal coronary angioplasty (PTCA) for stable angina. Patients were randomized to either: (1) intravenous heparin and nitroglycerin (GTN); or (2) intravenous heparin and isosorbide dinitrate. ⋯ Within-group analysis showed significantly lower APTT ratio and heparin concentrations at 4 hours compared with the respective 2 hour values. These results would suggest that there is a potential impairment of anticoagulation with low-dose intravenous nitroglycerin and to a lesser extent with low-dose isosorbide dinitrate. Early and frequent monitoring may therefore be appropriate when intravenous nitrates and heparin are used in combination.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of methohexitone and propofol ('Diprivan') for induction of enflurane anaesthesia in outpatients.
In 73 unpremedicated patients scheduled for minor outpatient oral surgery or restorative dentistry, enflurane anaesthesia was induced either with an emulsion formulation of propofol (2.5 mg/kg) or with methohexitone (2 mg/kg). Sensations at the site of the injection were more common when the drugs were injected into a vein in the dorsum of the hand (58% for propofol and 28% for methohexitone) when compared to a vein in the forearm or antecubital area (7 to 8% with sensations). After induction of anaesthesia intravenous suxamethonium was given, and endotracheal intubation carried out. ⋯ The incidence of nausea or vomiting was similar (27 to 33%) in both groups. It is concluded that both propofol in emulsion form and methohexitone are satisfactory induction agents in outpatient dentistry. Propofol provided a smoother induction of anaesthesia and recovery was as rapid as after anaesthesia induced with methohexitone.
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Randomized Controlled Trial Comparative Study Clinical Trial
Cumulative experience with propofol ('Diprivan') as an agent for the induction and maintenance of anaesthesia.
In 60 unpremedicated patients, anaesthesia induction time decreased when the time taken to inject a bolus of 2 mg/kg propofol was decreased from 60 s to 5 s. Apnoea at induction was noted in all groups but the degree of cardiorespiratory depression was not influenced by the rate of injection. ⋯ In comparison with thiopentone 4 mg/kg, propofol produced a greater degree of arterial hypotension and a smaller increase in heart rate. Preliminary results with an infusion of propofol for maintenance of anaesthesia suggest that rapid recovery can be achieved after operations of long duration.
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Randomized Controlled Trial Clinical Trial
The respiratory effects of meptazinol.
The respiratory effects of the new analgesic, meptazinol, were compared with a placebo and with equianalgesic doses of morphine and pentazocine and with diazepam in a double-blind crossover trial in seven healthy volunteers. No significant change in the ventilatory response to rebreathing carbon dioxide was observed after meptazinol or placebo but morphine, pentazocine and diazepam depressed the slope of the ventilatory response (-30.0%, -31.6% and -50.0% respectively, P less than 0.02). End-tidal carbon dioxide tension (PE',CO2) breathing air increased significantly following all three analgesic drugs but not after diazepam. ⋯ The increase following pentazocine (0.80 kPa) was significantly greater than that after both morphine and meptazinol (P less than 0.02). In a preliminary study of pain relief following cholecystectomy there was no significant difference in the analgesic effect of meptazinol compared to morphine, both drugs being given by continuous infusion. More of the patients given morphine had apnoeic periods, although the difference between the groups was not significant.