European journal of anaesthesiology
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Randomized Controlled Trial Comparative Study Clinical Trial
Increased nausea and dizziness when using tramadol for post-operative patient-controlled analgesia (PCA) compared with morphine after intraoperative loading with morphine.
Thirty-eight ASA I-III patients undergoing lower abdominal operations were randomly allocated to receive either morphine (group M, patient-controlled analgesia bolus = 1 mg of morphine) or tramadol (group T, patient-controlled analgesia bolus = 10 mg of tramadol) for post-operative patient-controlled analgesia (PCA) after receiving morphine intraoperatively. There were no between-group differences in the pain, sedation or vomit scores. ⋯ There was no difference in the overall satisfaction. We conclude that the use of tramadol, compared with morphine, for post-operative PCA after intraoperative loading with morphine is associated with more nausea and dizziness, but with similar sedation, quality of analgesia and patient satisfaction.
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Randomized Controlled Trial Clinical Trial
Cardiovascular responses, arterial oxygen saturation and plasma catecholamine concentration during upper gastrointestinal endoscopy using conscious sedation with midazolam or propofol.
Hypoventilation as a consequence of deep intravenous sedation is the most frequently reported cause of cardiac arrest during upper gastrointestinal endoscopy (UGIE). Haemodynamic stress can contribute to myocardial ischaemia; therefore, this study was designed to observe prospectively the cardiorespiratory changes during UGIE using either midazolam or propofol for conscious sedation. Thirty-four patients, aged 50 years and older, ASA physical status I-III, scheduled for elective UGIE with sedation, were studied. ⋯ In addition, plasma catecholamine concentrations were determined. The results of this study are consistent with previous reports that cardiopulmonary events may occur during endoscopy, with or without sedation. Both midazolam and propofol sedation may provide some protection against haemodynamic stress in response to insertion and manipulation of the endoscope, but sedation can also contribute to the occurrence of hypoxaemia.
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Randomized Controlled Trial Clinical Trial
Post-tetanic burst count and train-of-four during recovery from vecuronium-induced intense neuromuscular block under different types of anaesthesia.
Recovery of neuromuscular blockade after vecuronium 0.2 mg kg-1 was measured by post-tetanic burst count (PTBC) and train-of-four (TOF) in 120 adult patients anaesthetized by one of four techniques: neuroleptanaesthesia or one minimum alveolar concentration of isoflurane, enflurane, or sevoflurane. Onset of recovery was taken when there was reflex movement in response to carinal stimulation. The time course of recovery measured by burst count was similar for all four types of anaesthesia. ⋯ P < 0.05]. The burst count at the onset of reflex movement was less under neuroleptanaesthesia than under isoflurane, enflurane, or sevoflurane anaesthesia (16.3 +/- 4.8, 26.7 +/- 6.7, 27.7 +/- 6.8, 28.0 +/- 8.4, P < 0.05). The ratio of first twitch to control twitch at the onset of reflex movement was the same for all four types of anaesthesia.
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Fifty-five consecutive patients undergoing a short-stay ophthalmic operation (orbital hydroxyapatite implantation) were recruited over 1 year to assess the frequency and duration of post-operative nausea and vomiting over 7 days. The incidence of nausea and vomiting in hospital was recorded. Patients scored their nausea and vomiting four times daily at home. ⋯ However, there was a statistically significant correlation between nausea and pain. The high incidence of nausea and vomiting observed in this study appears to provide additional evidence of an oculo-emetic reflex. The timing of discharge and appropriate patient education are discussed.
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An audit of post-operative nausea and vomiting (PONV) was undertaken in 935 female patients who used morphine patient-controlled analgesia (PCA) for pain relief after major gynaecological operations in a district general hospital. We investigated retrospectively five different antiemetic policies and a reference group without policy from January 1993 to July 1995. The department's computerized audit system was used to analyse the observations. ⋯ This emphasizes the importance of corporate involvement in the development, formulation and evaluation of departmental protocols if compliance is to be high. We conclude that audit as a corporate effort improves the acceptance of departmental protocols. This reduces PONV significantly irrespective of the type of antiemetic drug used.