European journal of anaesthesiology
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Randomized Controlled Trial Comparative Study Clinical Trial
The influence of cyclizine and perphenazine on the emetic effect of meptazinol.
The effectiveness of 50 mg cyclizine and 2.5 mg perphenazine against the emetic sequelae of 100 mg meptazinol were studied in a randomized double-blind placebo-controlled trial. Three groups of 40 women received the opioid, together with an anti-emetic by i.m. injection, as premedication prior to minor gynaecological surgery. Beneficial or noxious effects were noted at standard time intervals and anaesthesia standardized as incremental methohexitone with nitrous oxide/oxygen. ⋯ Perphenazine, 2.5 mg, showed no useful anti-emetic effect. Both anti-emetics increased the soporific effect of premedication at the 90-min interval. Subjects receiving perphenazine experienced significantly more dizziness than those of other groups.
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Randomized Controlled Trial Comparative Study Clinical Trial
Droperidol, alizapride and metoclopramide in the prevention and treatment of post-operative emetic sequelae.
Women (182) undergoing elective orthopaedic surgery under general anaesthesia received 100 or 200 mg alizapride, 1.25 mg droperidol, 20 mg metoclopramide or a saline placebo intravenously 5-10 min before the end of anaesthesia in a double-blind random fashion to prevent post-operative nausea and vomiting. Administration of the same anti-emetic was repeated during 24 h post-operatively if the patient complained of nausea or retched or vomited. Significantly fewer patients given any of the anti-emetics prophylactically were nauseated or vomited in comparison with patients given saline. ⋯ The number of patients needing an additional dose of the same substance in the post-operative period was significantly higher in the saline group (67%) than in the groups which had received droperidol (32%, P less than 0.01) and alizapride 100 mg (37%, P less than 0.05) or 200 mg (33%, P less than 0.05). The patients who received metoclopramide, however, did not differ statistically from the saline group in the treatment of nausea and vomiting. It is concluded that droperidol was the most effective, and metoclopramide the least effective, anti-emetic in this study.
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Randomized Controlled Trial Clinical Trial
Intrathecal morphine in cardiac surgery.
The effects of intrathecal morphine in 60 patients undergoing open-heart surgery were studied in an observer-blind control trial. The patients were randomly allocated into three groups of 20 each: (A) Control, (B) 2 mg and (C) 4 mg of intrathecal morphine. This study confirms that intrathecal morphine provides useful post-operative analgesia. ⋯ Since the completion of this study, reports have suggested that 1 mg of morphine intrathecally avoids the serious complications of respiratory depression. In the study described, the patients were electively ventilated post-operatively and respiratory depression was therefore not a problem. Of the other associated side-effects of intrathecal morphine, vomiting (20%) and pruritus (20%) proved the most troublesome.
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Review
Systemic and specific autonomic reactions in pain: efferent, afferent and endocrine components.
The sympathetic nervous system is hierarchically organized. At the bottom of this organization are the sympathetic pre-post-ganglionic channels which supply the autonomic target organs, at the top the hypothalamus and cortical structures. Each level of this hierarchy contains neuronal programmes which govern the sympathetic activity in a patterned fashion. ⋯ No conclusive experimental evidence exists to show that peripheral nociceptors are controlled by activity in sympathetic post-ganglionic neurones. In certain pathophysiological situations, however, it may happen that activity in sympathetic post-ganglionic neurones, which supply an extremity, leads to excitation of afferent axons, thus establishing a vicious circle between primary afferent neurones, spinal cord and sympathetic outflow. This situation may occur after partial lesions of peripheral nerves in a syndrome which is called 'reflex sympathetic dystrophy'.
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In the in vivo rat sciatic nerve tibialis muscle preparation the potency and pharmacodynamics of vecuronium, atracurium, pancuronium, tubocurarine and their combinations were studied. Considering the potency only, there was no beneficial difference between the pure compounds and their combinations. As both vecuronium and atracurium are almost free from side-effects individually, a combination of the two relaxants brings no advantage.