European journal of anaesthesiology
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Meta Analysis Comparative Study
Prophylactic ondansetron for post-operative emesis: meta-analysis of its effectiveness in patients with and without a previous history of motion sickness.
The post-operative anti-emetic efficacy of 4 and 8 mg of ondansetron in adult patients with and without a previous history of motion sickness (PHMS) was assessed by meta-analysis. MEDLINE and EMBASE databases were searched for randomized placebo-controlled trials evaluating the anti-emetic effectiveness of ondansetron in a 24-h period. In the 49 studies found, a further selection was with respect to those studies that noted the patient's previous history of motion sickness. ⋯ The dose of 4 mg ondansetron was 71.5% more effective in previous history of motion sickness(+) than in previous history of motion sickness(-) patients. For the 8 mg dose, the odds ratios (95% CI) were: previous history of motion sickness(+) = 3.11 (1.40-6.93) and previous history of motion sickness(-) = 2.08 (1.35-3.21). The calculated number needed to treat was also more favourable in previous history of motion sickness(+) patients for both doses of ondansetron, demonstrating a higher effectiveness in this subgroup of patients.
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Randomized Controlled Trial Comparative Study Clinical Trial
Laryngeal mask airway insertion using propofol without muscle relaxants: a comparative study of pretreatment with midazolam or fentanyl.
We determined the effects of pretreatment with midazolam or fentanyl on the ease of laryngeal mask airway insertion using propofol without a muscle relaxant. One hundred and eighty ASA class I or II patients were randomly allocated to one of three groups, 60 patients per group, to receive either placebo (Group C), midazolam 0.05 mg kg-1 (Group M) or fentanyl 2 micrograms kg-1 (Group F), respectively. Following intravenous administration of these drugs, Group C received propofol 2.5 (Group C-2.5) or 3.0 mg kg-1 (Group C-3.0). ⋯ Airway obstruction and inadequate jaw relaxation, which were occasionally recognized in Group C and Group F patients, were not observed in Group M-2.5. Overall the ease of LMA insertion was significantly better in Group M-2.0, Group M-2.5 and Group F-2.5 than in Group C-2.5, however, the blood pressure in Group F after LMA insertion was significantly lower than in Group M. We conclude that pretreatment with midazolam 0.05 mg combined with propofol 2.5 mg kg-1 provides safe and satisfactory conditions for LMA insertion.
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Comparative Study Clinical Trial
Splanchnic perfusion during controlled hypotension with haemodilution under isoflurane anaesthesia in elderly patients.
We investigated the effects of controlled hypotension with haemodilution under isoflurane anaesthesia on splanchnic perfusion in elderly patients. We determined the intramucosal pH using gastric tonometry in 28 patients scheduled for hip surgery. Patients without cardiac disease were assigned to two groups according to age. ⋯ The gastric pHi values showed significant decreases from 7.418 +/- 0.035 to 7.334 +/- 0.024 (P < 0.05) in group A and from 7.428 +/- 0.029 to 7.320 +/- 0.039 (P < 0.05) in group B after haemodilution, while no further decreases were found at 80 min after starting the hypotension (7.329 +/- 0.038 in group A and 7.322 +/- 0.031 in group B) and 60 min after recovery from hypotension (7.331 +/- 0.029 in group A and 7.328 +/- 0.034 in group B). It can be concluded that moderate haemodilution under isoflurane anaesthesia might impair splanchnic perfusion in adult and elderly patients. The addition of controlled hypotension with PGE1 or an increase in age did not further impair splanchnic perfusion nor the splanchnic oxygen supply.
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We report a case of accidental intra-arterial injection of propofol in a 30-year-old woman admitted for curettage. The patient reported pain, which was followed by a hyperaemic area of 6 x 7 cm around the injection site. Later a blanching of the distal part of the hand was noticed, lasting for 3 min. When pain appears during propofol administration, an intra-arterial injection must be excluded.