European journal of anaesthesiology
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Randomized Controlled Trial Clinical Trial
Tracheal intubation without muscle relaxants: remifentanil or alfentanil in combination with propofol.
In some situations, the use of muscle relaxants (neuromuscular blocking drugs) are undesirable or contraindicated. We compared intubating conditions without muscle relaxants in premedicated patients receiving either alfentanil 40 microg kg(-1) or remifentanil 2, 3 or 4 microg kg(-1) followed by propofol 2 mg kg(-1). ⋯ Remifentanil 4 microg kg(-1) and propofol 2 mg kg(-1) administered in sequence intravenously provided good or excellent conditions for tracheal intubation in all patients without the use of muscle relaxants.
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Randomized Controlled Trial Clinical Trial
Cricoid yoke: the effect of surface area and applied force on discomfort experienced by conscious volunteers.
The application of cricoid force is central to techniques that reduce the risk of gastric regurgitation and the subsequent pulmonary aspiration associated with obstetric and emergency anaesthesia. The discomfort associated with cricoid force in awake preoperative patients increases the incidence of coughing, struggling and pain during induction of anaesthesia. This study determined if increasing the surface area of a cricoid yoke reduced the associated discomfort in volunteers. ⋯ The larger yoke was tolerated better by volunteers when clinically relevant cricoid forces were applied.
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The efficacy of the Trendelenburg position, a common first step to treat suspected hypovolaemia, remains controversial. We evaluated its haemodynamic effects on cardiac preload and performance in patients after cardiac surgery. ⋯ Trendelenburg's manoeuvre caused only a slight increase of preload volume, despite marked increases in cardiac-filling pressures, without significantly improving cardiac performance.
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Randomized Controlled Trial Comparative Study Clinical Trial
Increasing the injection volume by dilution improves the onset of motor blockade, but not sensory blockade of ropivacaine for brachial plexus block.
Ropivacaine used for axillary plexus block provides effective motor and sensory blockade. Varying clinical dosage recommendations exist. Increasing the dosage by increasing the concentration showed no improvement in onset. We compared the behaviour of a constant dose of ropivacaine 150 mg diluted in a 30, 40 or 60 mL injection volume for axillary (brachial) plexus block. ⋯ The data show that the onset of motor, but not of sensory block, is accelerated by increasing the injection volume to 60 mL using ropivacaine 150 mg for axillary plexus block. This may be useful for a more rapid determination of whether the brachial plexus block is effective. However, when performing surgery in the area of the block, sensory block onset seems more important.
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Randomized Controlled Trial Clinical Trial
Effects of different doses of oral ketamine for premedication of children.
A need exists for a safe and effective oral preanaesthetic medication for use in children undergoing elective surgery. The study sought to define the dose of oral ketamine that would facilitate induction of anaesthesia without causing significant side-effects. ⋯ It is concluded that oral ketamine 8 mg kg(-1) is an effective oral premedication in inpatient children undergoing elective surgery.