European journal of anaesthesiology
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of omeprazole with cimetidine for prophylaxis of acid aspiration in elective surgery.
Gastric pH and volume were measured in four groups of 15 patients scheduled for elective surgery. The patients were randomly allocated to receive either no antacid, oral omeprazole 40 mg the evening before surgery, oral omeprazole 40 mg 2 h before surgery, or effervescent cimetidine 800 mg, 2 h before surgery. Anaesthesia was induced with thiopentone (4-6 mg kg-1), fentanyl (0.03 mg kg-1) and vecuronium (0.1 mg kg-1) and maintained with nitrous oxide in oxygen (50/50) and isoflurane. ⋯ Gastric pH were significantly higher in the three treated groups than in control (P < 0.01). Omeprazole and cimetidine were equally effective in reducing volume and pH of the gastric juice at the beginning and at the end of anaesthesia. Nevertheless 14.2 and 28.5% of patients who received omeprazole respectively the day before or the morning of surgery remained at risk of aspiration pneumonitis (gastric pH < 2.5 and gastric volume > 25 ml).
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Randomized Controlled Trial Comparative Study Clinical Trial
Epidural analgesia for labour using a continuous infusion of bupivacaine and alfentanil.
Seventy women who requested epidural pain relief in labour received a continuous epidural infusion at 8 ml h-1, which contained either 0.25% bupivacaine (n = 29), or a mixture of 0.125% bupivacaine and 0.005% alfentanil (n = 31), assigned randomly. Increments of 4 ml 0.25% bupivacaine were given on demand to prevent residual pain from uterine contractions. ⋯ One of the women receiving the mixture and eight of the women receiving bupivacaine alone had almost complete motor block. There were no differences in the mode of delivery or in the neonatal Apgar scores.
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Randomized Controlled Trial Clinical Trial
Effects of acupuncture and transcutaneous stimulation analgesia on plasma hormone levels during and after major abdominal surgery.
The effects of acupuncture and transcutaneous electrical stimulation (TES) on plasma adrenaline (A) and noradrenaline (NA), adrenocorticotropic hormone (ACTH), beta-endorphin (beta E), anti-diuretic hormone (ADH) and hydrocortisone (cortisol) were evaluated during and, for four days after surgery in 42 male patients submitted to a standardized major abdominal operation in a comparative study of three different anaesthetic techniques. Group 1 received acupuncture and transcutaneous stimulation as the main non-pharmacological analgesic during surgery. Group 2 received moderate-dose fentanyl (initial bolus of 10 micrograms kg-1 followed by continuous infusion of 5 micrograms kg-1 h-1 for the first hour, and then 4 micrograms kg-1 h-1. ⋯ Group 3). It is concluded that acupuncture and TES have no effect on the cardiovascular response to laryngoscopy and intubation. They can replace moderate-dose fentanyl anaesthesia in major abdominal surgery at the cost of a more enhanced per-operative neuroendocrine stress response, which does not, however, influence the postoperative hormonal profiles nor the rapidity of return to pre-operative values.
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Randomized Controlled Trial Clinical Trial
Central nervous system symptoms after intravenous lignocaine: dose-response during pregnancy.
There is continuing controversy over what dose of what drug should be used to identify an accidental intravascular or subarachnoid catheter placement in obstetric epidural anaesthesia. The purpose of this randomized, double-blind study was to evaluate the dose-effect relationship for the production of central nervous system (CNS) symptoms by intravenous lignocaine. ⋯ An ED95 of 1.12 mg kg-1 was calculated to produce reliable CNS symptoms when injected intravascularly. Lignocaine is an effective and reliable marker for intravenous injection in pregnant women.
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Randomized Controlled Trial Clinical Trial
Effect of intravenous diclofenac on pain and recovery profile after day-case laparoscopy.
Diclofenac sodium, 100 mg, or saline was given intravenously after the induction of anaesthesia to 169 patients undergoing outpatient gynaecological diagnostic laparoscopy or laparoscopic sterilization by tubal ligation. Propofol was used as the main anaesthetic agent and fentanyl and paracetamol were given for post-operative pain relief. In the post-anaesthesia care unit the amount of analgesics given and the incidence of nausea and vomiting were recorded. ⋯ However, patients in the tubal ligation group needed significantly more post-operative analgesia than patients in the laparoscopy group. Diclofenac had no influence on the rapidity of recovery or home readiness in either group. It is concluded that diclofenac has no influence on home readiness, but prevents postoperative pain in patients undergoing diagnostic laparoscopies, whereas it was not a potent enough analgesic to prevent pain after laparoscopic tubal ligation.