European journal of anaesthesiology
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Randomized Controlled Trial Comparative Study Clinical Trial
Regional anaesthesia for circumcision. Subcutaneous ring block of the penis and subpubic penile block compared.
In this prospective study techniques for the subcutaneous ring block of the penis and subpubic block of the penis for analgesia after circumcision were compared. Forty-five boys having circumcision as day-case patients were allocated randomly to have either a subcutaneous ring block or a subpubic penile block. The blocks were inserted after induction of anaesthesia but before surgery. ⋯ Four of the 24 boys who had subpubic penile blocks and nine of the 16 boys who had subcutaneous ring blocks were given morphine for post-operative pain (P = 0.015). The surgeons complained about oedematous tissues in three patients, all of whom had had subcutaneous ring blocks. The subpubic penile block provided significantly better analgesia than the subcutaneous ring block of the penis.
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Randomized Controlled Trial Clinical Trial
Dose-response and concentration-response relation of rocuronium infusion during propofol-nitrous oxide and isoflurane-nitrous oxide anaesthesia.
The dose-response and concentration-response relation of rocuronium infusion was studied in 20 adult surgical patients during propofol-nitrous oxide and isoflurane (1 MAC)-nitrous oxide anaesthesia. Neuromuscular block was kept constant, initially at 90% and then at 50% with a closed-loop feedback controller. At 90% block the steady-state infusion of rocuronium was 0.55 +/- 0.16 mg kg-1 h-1 and the corresponding concentration 1714 +/- 281 ng mL-1 in patients receiving propofol. ⋯ At 50% block isoflurane reduced the rate of infusion by 52% (P < 0.005) and the concentration by 59% (P < 0.001); at 90% block both the mean infusion rate and the concentration of rocuronium were reduced by 35% (P < 0.005). The mean rocuronium clearance at 50% block was unaffected by the type of anaesthesia; it was 4.1 +/- 1.6 and 4.9 +/- 2.7 mL kg-1 min-1 in the groups receiving propofol and isoflurane anaesthesia, respectively. We conclude that isoflurane reduces the infusion requirements of rocuronium by changing the pharmacodynamic behaviour.
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Randomized Controlled Trial Clinical Trial
Acute haemodilution and prostaglandin E1-induced hypotension: effects on the coagulation-fibrinolysis system.
The effects of acute haemodilution, during prostaglandin E1 (PGE1)-induced hypotension, on the blood coagulation-fibrinolysis system were studied in 40 patients undergoing hip surgery. The patients were randomly divided into four groups of 10 patients each; Group A (control) received no induced hypotension or haemodilution, group B received hypotension alone, group C received haemodilution alone and group D received the combination of induced hypotension and haemodilution. Haemodilution in groups C and D was produced by drawing approximately 1000 mL of blood and replacing it with the same amount of 6% hydroxyethyl starch. ⋯ Haemodilution alone caused significant decreases in PLT (-43%), PT (+21%), FIB (-33%), AT-III (-21%) and PLG (-27%), and a significant increase in aPTT (+26%), whereas the combination of PGE1-induced hypotension did not cause any further change in these parameters. Serum-fibrin degradation products (FDP) significantly increased (+300%) and PLG significantly decreased (-30%) after surgery in all groups. It can be concluded that acute haemodilution to a haematocrit value of 22 +/- 2% causes a slight coagulopathy, which is not enhanced when combined with PGE1-induced hypotension.
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There are only limited data on sevoflurane minimum alveolar concentration (MAC) in rats. This study was designed to determine the minimum alveolar concentration value for sevoflurane in younger and older rats. Minimum alveolar concentration determination was performed in spontaneously breathing animals, 9-week-old rats (younger, n = 8) and more than 13-month-old rats (older, n = 8). ⋯ Minimum alveolar concentration for sevoflurane in younger rats was significantly higher than in the older rats (2.68 +/- 0.19 vs. 2.29 +/- 0.19, P < 0.001). Subgroup analysis indicated that minimum alveolar concentration for sevoflurane was not affected by the presence of an arterial catheter in the abdominal aorta (younger, 2.75 +/- 0.08 vs. 2.67 +/- 0.21; older, 2.23 +/- 0.19 vs. 2.30 +/- 0.18). Minimum alveolar concentration is profoundly affected by the age of the animal, but not by limited instrumentation.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Transition to post-operative epidural or patient-controlled intravenous analgesia following total intravenous anaesthesia with remifentanil and propofol for abdominal surgery.
Remifentanil is an ultrashort acting mu opioid, well suited to total intravenous (i.v.) anaesthesia. Pain immediately following emergence from anaesthesia is a potential problem because of the rapid offset. This study investigated the transition from remifentanil/propofol total intravenous anaesthesia to post-operative analgesia with epidural or patient controlled analgesia morphine in 22 patients undergoing major abdominal surgery. ⋯ A smooth transition was then made to either epidural analgesia or patient controlled analgesia with morphine; pain scores were not significantly changed during the transition. Nausea occurred in 16 of the 22 patients, but only following administration of morphine. Epidural analgesia produced significantly lower pain scores on the surgical ward compared with patient controlled analgesia.