Lancet
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Randomized Controlled Trial Clinical Trial
Error in blood-pressure measurement due to incorrect cuff size in obese patients.
Trained nurse-specialists obtained 84 000 blood-pressure measurements in 1240 obese subjects using cuffs of the three standard adult sizes in a randomised order. The differences in readings between the three cuffs were smallest in non-obese subjects and became progressively greater with increasing arm circumference (AC) in the obese population. ⋯ Formulae and a table have been derived to correct the measurement error caused by cuffs of inappropriate size at various ACs. The reported high prevalence of hypertension in obese subjects may be greatly overestimated.
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Randomized Controlled Trial Comparative Study Clinical Trial
Analgesic efficacy of parenteral metkephamid acetate in treatment of postoperative pain.
The analgesic efficacy and side-effects of a single parenteral dose of metkephamid acetate 70 mg were compared with those of pethidine (meperidine) hydrochloride 100 mg and placebo in a double-blind, randomised, controlled clinical trial. 30 out of 32 postoperative patients completed the study--10 in the metkephamid group, 11 in the pethidine group, and 9 in the placebo group. The time-effect curves of summated pain measures and analyses of derived measures all indicated that the analgesic activity of metkephamid 70 mg was significantly greater than that of placebo and not less than that of pethidine 100 mg. The metkephamid group had a greater incidence of side-effects than the other two treatment groups. Some side-effects, such as sensations of heaviness of the extremities and nasal congestion, were peculiar to metkephamid but not distressing.
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Randomized Controlled Trial Clinical Trial
Fetal and neonatal hazards of maternal hydration with 5% dextrose before caesarean section.
In a prospective randomised study, 47 fasting women undergoing elective caesarean section received one of the following three glucose regimens for prevention of hypotension before administration of epidural bupivacaine to produce anaesthesia from the T4 sensory level: (i) 150 ml of 5% dextrose in water (D5W) and 1000 ml normal saline (7.5 g dextrose); (ii) 150 ml of D5W, 350 ml of 5% dextrose in normal saline (D5NS), and 650 ml of normal saline (25 g dextrose); (iii) 150 ml D5W and 1000 ml D5NS (57.5 g dextrose). The maternal blood sugar at delivery was significantly raised in patients receiving 25 and 57.5 g of dextrose. 57.5 g of dextrose also raised the mean umbilical cord venous levels of glucose to 11.7 mmol/l and of insulin to 70 +/- 7 microU/ml, while decreasing glucagon to 24 +/- 5.3 pg/ml and arterial pH to 7.19 +/- 0.015 compared with the levels with 7.5 g dextrose. ⋯ The addition of large amounts of dextrose to intravenous fluids was harmful to the fetus and of no benefit to the mother. Until a safe rate of administration is established, it is recommended that dextrose infusions immediately before delivery be limited to no more than 6 g/h.
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Randomized Controlled Trial Comparative Study Clinical Trial
Co-trimoxazole versus non-absorbable antibiotics in acute leukaemia.
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Randomized Controlled Trial Clinical Trial
Effect on mortality of metoprolol in acute myocardial infarction. A double-blind randomised trial.
The effect of metoprolol on mortality was compared with that of placebo in a double blind randomised trial in patients with definite or suspected acute myocardial infarction. Treatment with metoprolol or placebo started as soon as possible after the patient's arrival in hospital and was continued for 90 days. Metoprolol was given as a 15 mg intravenous dose followed by oral administration of 100 mg twice daily. 1395 patients (697 on placebo and 698 on metoprolol) were included in the trial. ⋯ Patients were allocated to various risk groups and within each group patients were randomly assigned to treatment with metoprolol or placebo. There were 62 deaths in the placebo group (8.9%) and 40 deaths in the metoprolol group (5.7%), a reduction of 36% (p less than 0.03). Mortality rates are given according to the treatment group to which the patients were initially randomly allocated.