European journal of anaesthesiology
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Randomized Controlled Trial Clinical Trial
An assessment of prochlorperazine buccal for the prevention of nausea and vomiting during intravenous patient-controlled analgesia with morphine following abdominal hysterectomy.
The effectiveness of prochlorperazine buccal as an anti-emetic for the prevention of post-operative nausea and vomiting in patients using intravenous patient-controlled analgesia with morphine following abdominal hysterectomy has been assessed in a randomized, double-blind, placebo-controlled study. Forty-nine female patients participated with 26 allocated to the prochlorperazine buccal group and the remainder to the placebo group. Each received either placebo or prochlorperazine buccal 6 mg, in each case by the buccal route, 1 h prior to anaesthesia with further doses at 6, 18, 30 and 42 h, respectively. ⋯ Intravenous droperidol is the current gold standard prophylactic anti-emetic in post-operative nausea and vomiting associated with intravenous patient controlled analgesia with morphine usage. This study has demonstrated a peri-operative prochlorperazine buccal regimen to be effective in post-operative nausea and vomiting prophylaxis in the use of intravenous patient controlled analgesia with morphine. Prochlorperazine buccal should be considered as an effective, inexpensive option for the prevention of post-operative nausea and vomiting in post-operative intravenous patient controlled analgesia with morphine administration.
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Randomized Controlled Trial Comparative Study Clinical Trial
Movement response to skin incision: analgesia vs. bispectral index and 95% spectral edge frequency.
We studied the movement response to skin incision in 68 adult (males/females) ASA I-II patients receiving propofol +/- fentanyl intravenous anaesthesia using the bispectral index and 95% spectral edge frequency monitoring with an A-1050 EEG monitor. Following Ethics Committee approval, patients were randomly assigned to one of the following four treatments: Group P (n = 17): propofol infusion, 1 mg kg-1 min-1 intravenous for 2 min, followed by propofol infusion, 200 micrograms kg-1 min-1, until skin incision; Group PF1 (n = 17): fentanyl bolus, 1 microgram kg-1 intravenous + propofol infusion as in Group P; Group PF2 (n = 17): fentanyl bolus, 2 micrograms kg-1 intravenous + propofol infusion as in Group P; and Group PF3 (n = 17): fentanyl bolus, 3 micrograms kg-1 intravenous + propofol infusion as in Group P. The bispectral index and 95% spectral edge frequency were monitored continuously and recorded prior to induction of anaesthesia (base-line) and at skin incision. ⋯ However, only bispectral index values were significantly lower in the nonmovement as compared with the movement (M) category (32.6 +/- 8.9 vs. 37.4 +/- 10.3; P = 0.04). Though deeper levels of hypnosis to lower bispectral index and 95% spectral edge frequency values may be effective in preventing the movement response to skin incision, provision of adequate analgesia rather than lower bispectral index and 95% spectral edge frequency (clinical maintenance) values may be more reliable for preventing the response to skin incision as bispectral index and 95% spectral edge frequency measure the hypnotic component of the anaesthetic effect. Lower bispectral index values may be more discriminatory as compared with 95% spectral edge frequency values for preventing the movement response to skin-incision.
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Clinical Trial
Computed tomographic epidurography: an aid to understanding deformation of the lumbar dural sac by epidural injections.
Local anaesthetics injected into the epidural space may deform the dural sac to a variable degree, thereby contributing to variability in the extent of the block. We investigated deformation of the lumbar dural sac after injection into the lumbar epidural space. The subjects were 26 patients with low-back pain who underwent lumbar epidurography and computed tomographic (CT) epidurography, of whom seven also underwent myelography and computed tomographic myelography. ⋯ This line was though to be a manifestation of the dural deformation to the inverted triangle. Dural sac deformation usually shows a specific pattern, although there are individual variations. Dural deformability is an important consideration in any analysis of the spread of epidural block or of the changes of epidural pressure after epidural injection of local anaesthetics.
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The dose-related effects of milrinone, a phosphodiesterase (PDE) III inhibitor, on the contractility of fatigued diaphragm were studied in dogs. Animals were divided into three groups of eight each. Diaphragmatic fatigue was induced by intermittent supramaximal bilateral electrophrenic stimulation at a frequency of 20 Hz applied for 30 min. ⋯ Compared with Group I, transdiaphragmatic pressure to each stimulus increased during milrinone infusion in Groups II and III (P < 0.05). The increase in trans-diaphragmatic pressure was greater in Group III than in Group II (P < 0.05). It is concluded that milrinone is associated with a dose-related effect on the contractility of fatigued diaphragm in dogs.