European journal of anaesthesiology
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of the effects of sevoflurane and total intravenous anaesthesia in percutaneous nephrolithotomy.
Although percutaneous nephrolithotomy has many advantages over open surgery, some endocrine and haemodynamic responses have been reported. However, the effects of anaesthetic agents on these responses have not previously been reported. This study compared the effects of sevoflurane and total intravenous anaesthesia using propofol and alfentanil on the haemodynamic and hormonal changes during percutaneous nephrolithotomy. ⋯ In the sevoflurane group, the concentrations of renin, aldosterone and adrenocorticotrophic hormone were significantly higher after 15 min of irrigation compared with the total intravenous anaesthesia group. Although the clinical significance of this difference was not clear, these changes should be considered in certain patient groups.
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The use of muscle relaxants, considered until recently as common practice in current neurosurgical anaesthesia protocols, becomes increasingly more questionable today. The reasons rely on the evolution of neurosurgery including the advent of new surgical techniques, the evolution of anaesthesia having the benefit of new drugs and devices, and the rationale for using muscle relaxants balanced against their potential side-effects and possible pharmacodynamic alterations in neurosurgical patients.
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Clinical Trial Controlled Clinical Trial
Elimination of alfentanil delivered by infusion is not altered by the chronic administration of atorvastatin.
Statins are prescribed for patients with hypercholesterolemia. Atorvastatin is metabolized by cytochrome P4503A4 and inhibits P4503A4 activity in vitro. Alfentanil is a potent opioid used in clinical anaesthetic practice and is also metabolized by P4503A4. This study tested the hypothesis that chronic atorvastatin administration inhibits the metabolism of alfentanil. ⋯ Concurrent atorvastatin administration does not alter the pharmacokinetics of alfentanil in patients undergoing elective surgery.
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Randomized Controlled Trial Clinical Trial
Epidural levobupivacaine, ropivacaine and bupivacaine in combination with sufentanil in early labour: a randomized trial.
To evaluate the efficacy, delay and duration of analgesia of three equianalgesic epidural doses of levobupivacaine, ropivacaine and bupivacaine during the first stage of labour. ⋯ During early labour, equipotent low concentrations of levobupivacaine, ropivacaine and bupivacaine, all with the addition of sufentanil 10 microg, produced similar pain relief and motor block, but levobupivacaine and ropivacaine produced a longer lasting analgesia. About 10% of parturients had inadequate analgesia with a single bolus of the tested solutions.
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To evaluate the effects of pneumoperitoneum and the reverse Trendelenburg position on respiratory mechanics and blood-gases in morbid obese patients with chronic obstructive pulmonary disease and hypertension. ⋯ In morbid obese patients with chronic obstructive pulmonary disease and hypertension, a 20 degrees reverse Trendelenburg position improved respiratory mechanics and oxygenation without any apparent adverse effects on haemodynamics during laparoscopic gastric banding surgery.