European journal of anaesthesiology
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Randomized Controlled Trial Clinical Trial
The post-operative analgesic action of midazolam following epidural administration.
To study post-operative analgesia with epidural midazolam, 30 patients who had undergone upper abdominal surgery were divided into two equal groups. When patients complained of pain, they were given either 6 microliters 0.25% bupivacaine (control group) or 6 microliters 0.25% bupivacaine + 0.05 mg kg-1 midazolam (midazolam group) epidurally at a single level between T7 and T12. Blood pressure and heart rate were similar in the two groups. ⋯ The area of analgesia was significantly larger in the midazolam group 10 and 30 min after administration and involved the entire spinal area and the head and face 10 min after administration in six patients. Amnesia was observed in 14 patients in the midazolam group but in only one in the control group. Epidural midazolam together with bupivacaine adds central analgesic, sedative, and amnesic effects to spinal analgesia and is useful for managing post-operative pain.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of intravenous and inhalational maintenance anaesthesia for endoscopic procedures in the aspirin intolerance syndrome.
Intravenous (n = 21) and inhalational maintenance anaesthesia (n = 21) were compared by random allocation in patients with the aspirin intolerance syndrome undergoing endoscopic nasal procedures. Premedication was with oral midazolam and intravenous methylprednisolone sodium succinate 10 mg kg-1. Anaesthesia was induced in both groups with etomidate and alfentanil and ventilation was controlled. ⋯ On later challenge testing, 125 mg of intravenous methylprednisolone significantly reduced the peak expiratory flow (P < 0.05) in one of these patients. The results suggest that intravenous and inhalational maintenance anaesthesia are equally suitable for patients with aspirin intolerance syndrome. Corticosteroids during surgery should be given by the same route used pre-operatively (spray, oral, or spray plus oral) because intravenous injection may have adverse effects.
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Randomized Controlled Trial Comparative Study Clinical Trial
The effects of propofol on laryngeal reactivity and the haemodynamic response to laryngeal mask insertion.
The ease of the insertion of laryngeal mask and the haemodynamic response were assessed 2 min after induction of anaesthesia with either propofol 2.5 mg kg-1 or thiopentone 4.0 mg kg-1 in 38 ASA I premedicated patients. The inserting conditions scored as excellent, good, poor and unable to insert were significantly better with propofol than with thiopentone (P < 0.001). Insertion of the laryngeal mask was followed by a transient but significant increase in both systolic (P < 0.05) and diastolic (P < 0.01) arterial pressure in the thiopentone group; there was no comparable response in the propofol group. The heart rate varied little from baseline in both groups.
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Randomized Controlled Trial Clinical Trial
Effects of prostaglandin E1 on intra-operative central and peripheral temperatures during upper abdominal surgery.
Effects of prostaglandin E1 (PGE1) on temperatures during upper abdominal surgery under isoflurane anaesthesia were studied. Forty-five patients were randomly assigned to one of three groups (15 patients per group). One group received 0.05 micrograms kg-1 min-1 of PGE1, the second group received 0.1 microgram kg-1 min-1 of PGE1 just after the induction of anaesthesia, and the third group received no PGE1 during anaesthesia (control). ⋯ In the 0.1 microgram kg-1 min-1 group, maximum decrease of tympanic membrane temperature was significantly larger than that in the control group. Fingertip temperatures in the 0.05 micrograms kg-1 min-1 group during surgery were significantly higher than those in the control group. This result suggests that 0.05 micrograms kg-1 min-1 of PGE1 may be superior to 0.1 microgram kg-1 min-1 of PGE1 for maintaining central and peripheral temperatures during surgery and general anaesthesia.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Comparison of tramadol with morphine for post-operative pain following abdominal surgery.
In a multi-centre, double-blind, randomized study involving 523 patients, the analgesic efficacy of tramadol was compared to that of morphine given in repeated intravenous boluses as required to control post-operative pain following abdominal surgery over 24 h. Intravenous administration of the study analgesic started as soon as the patient reported pain. Patients received an initial dose (either tramadol 100 mg or morphine 5 mg) and, if necessary, repeat doses of tramadol 50 mg or morphine 5 mg could be given on demand over the first 90 min. ⋯ Whilst responder rates reached 72.6% with tramadol and 81.2% with morphine, the treatments were statistically equivalent and the observed difference in the responder rates between the groups was within the predefined range of +/- 10%. Mean cumulative doses received by treatment responders amounted to 188.2 mg within the first 1.5 h and 157.1 mg during the subsequent 22.5 h in the tramadol group and 13.9 and 18.4 mg, respectively, in the morphine group. A high incidence of gastrointestinal adverse events were observed with both treatments mostly consisting of mild nausea, dry mouth, vomiting, dyspepsia and hiccups.