European journal of anaesthesiology
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Randomized Controlled Trial Comparative Study Clinical Trial
Topical anaesthesia of the larynx: cocaine or lignocaine?
A double-blind, randomized study compared the cardiovascular responses and extubation conditions using lignocaine or cocaine for topical anaesthesia of the larynx. Absorption of both agents from the trachea was quantified by serial venous plasma concentrations. Serial blood pressure, ECG, O2 saturation and end-tidal carbon dioxide measurements were obtained. ⋯ No difference was found in cardiovascular measurements between the two groups. The patterns of absorption of cocaine and lignocaine from the laryngeal mucosa were very similar, with peak absorption occurring at 10-15 min after laryngeal spraying. Although cocaine reduced the incidence of post-operative coughing when compared with lignocaine, this did not reach statistical significance.
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Randomized Controlled Trial Comparative Study Clinical Trial
Dreaming and anaesthesia: total i.v. anaesthesia with propofol versus balanced volatile anaesthesia with enflurane.
Sixty consecutive ASA Grades I and II patients scheduled for elective ear, nose and throat surgery were randomly assigned to receive either total i.v. anaesthesia with propofol ('propofol group') or 'balanced technique' with thiopentone induction followed by N2O and enflurane. Patients were asked whether they had experienced dreams immediately after extubation when verbal communication was established, in the recovery room and in the ward on the evening of the day of surgery. ⋯ In the recovery room and in the ward only three patients of the propofol group (10%) and one patient in the enflurane group (3%) remembered that they had been dreaming (NS). To avoid underestimating the frequency of peri-operative dreaming, post-operative interviews should take place as soon as possible after conversing is possible.
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Randomized Controlled Trial Clinical Trial
Effect of pre-operative metoprolol on cardiovascular and catecholamine response and bleeding during hysterectomy.
The effect of a pre-operative dose of metoprolol on the catecholamine and cardiovascular responses to tracheal intubation and surgery, cardiac complications and intra-operative blood loss, were studied in patients undergoing elective hysterectomy during general anaesthesia. The study was double-blind and placebo controlled. The patients received metoprolol 100 mg or placebo orally 1-25 h before anaesthesia. ⋯ The incidence of arrhythmias was less after metoprolol. The mean operative blood loss was greater in the placebo group (486 +/- 170 ml (SEM) compared to 231 +/- 43 ml (SEM) after metoprolol). We conclude that oral premedication with metoprolol attenuates the hypertensive response to tracheal intubation and reduces both arrhythmias and operative blood loss.
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Randomized Controlled Trial Comparative Study Clinical Trial
A haemodynamic comparison of epidural versus intrathecal sufentanil to supplement general anaesthesia for abdominal aortic surgery.
The present study was designed to evaluate the influence of epidural sufentanil (ES) and intrathecal sufentanil (IS) on the peri-operative haemodynamic responses during abdominal aortic surgery. Twenty-four ASA Grade II patients without clinical symptoms of coronary artery disease received, randomly, epidural (n = 12) or intrathecal (n = 12) sufentanil combined with light general anaesthesia for elective bifemoral grafting for aorto-iliac occlusive disease. The IS group contained significantly more hypertensive patients than the ES group. ⋯ Revascularization produced significant differences in HR, SVR and CI in both groups in comparison with the pre-declamping period. Notable was the maintenance of systemic blood pressure following revascularization due to preservation of sympathetic activity. It was concluded that both epidural and intrathecal sufentanil produce comparable and stable haemodynamics in this category of patients.
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Randomized Controlled Trial Comparative Study Clinical Trial
General anaesthesia versus epidural anaesthesia for primary caesarean section--a comparative study.
Forty-seven healthy parturients undergoing elective Caesarean section were randomly allocated to either general anaesthesia (n = 24) or epidural anaesthesia (n = 23) under standardized anaesthetic and surgical conditions. Seven women of the epidural group required additional systemic analgesia or sedation following delivery of the neonate. Nine of 24 newborns obtained 1-min Apgar scores below 7 after general anaesthesia compared to only 3/23 after epidural anaesthesia. ⋯ Our investigation did not show either the incision-delivery interval or the start of operation-delivery interval to play a role in neonatal outcome. Epidural anaesthesia is superior to general anaesthesia in Caesarean section under normal conditions with regard to neonatal outcome. Whether this is also true for critical conditions cannot be concluded from this study.