Anaesthesia and intensive care
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Anaesth Intensive Care · May 2010
Randomized Controlled Trial Comparative StudyAnti-emetic effect of midazolam added to morphine patient-controlled analgesia after total abdominal hysterectomy.
Nausea and vomiting are frequent adverse effects of patient-controlled analgesia with opioids. This study was designed to compare the effect of midazolam to that of ondansetron for prevention of nausea and vomiting during morphine patient-controlled analgesia. In a randomised, double-blind, prospective trial, 90 patients were allocated to one of three groups of 30 each, to receive one of three patient-controlled analgesia regimens to manage postoperative pain: a combination of midazolam and morphine (group M), a mixture of ondansetron and morphine (group O) or morphine alone (group C). ⋯ The frequency of nausea and vomiting was significantly lower in groups M (27%) and O (37%) compared with group C (70%) (P < 0.05). The incidence of mild sedation in group M was significantly higher than that in groups O or C (P < 0.05). We conclude that midazolam is as effective as ondansetron in preventing opioid-induced nausea and vomiting following total abdominal hysterectomy and has acceptable side-effects.
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Anaesth Intensive Care · May 2010
An evaluation of the laryngeal mask airway supreme' in 100 patients.
The Laryngeal Mask Airway (LMA) Supreme is a new supraglottic airway incorporating features of the LMA Proseal, LMA Fastrach and LMA Unique. We evaluated the LMA Supreme in 100 patients with normal airways having elective surgery. Our success rates of insertion and ventilation were 96% at the first attempt and 100% after two attempts. ⋯ The incidence of blood staining on removal was 7% and 7% of patients had mild sore throat one hour postoperatively. One patient who had been placed in the left lateral position during surgery had left lingual nerve palsy postoperatively, which recovered completely after one month. Our findings suggest that in patients with normal airways, the LMA Supreme is easy to insert and provides a satisfactory airway with adequate seal pressures for ventilation.
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Anaesth Intensive Care · May 2010
A retrospective audit of three different regional anaesthetic techniques for circumcision in children.
Postoperative analgesia for male circumcision surgery has been traditionally provided by a landmark-based dorsal penile nerve block (DPNB-LM) or by caudal epidural analgesia (CEA). In this study we report on a retrospective analysis of the effectiveness and safety of CEA, DPNB-LM and ultrasound-guided dorsal penile nerve block (DPNB-US) in our institution over a six-year period. Information was gathered from each patient's medical record. ⋯ Time to first analgesia was greatest for the CEA group while there was no significant difference between time to first analgesia for DPNB-LM and DPNB-US. Sixty-three percent of patients in the DPNB-LM group, 1.7% of CEA and 5.5% of the DPNB-US required intraoperative opiates (P < 0.0001). There was no difference in time to hospital discharge.
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Anaesth Intensive Care · May 2010
Effects of open lung approach policy on mechanical ventilation duration in postoperative patients with chronic thromboembolism with pulmonary hypertension: a case-matched study.
Patients with chronic thromboembolism with pulmonary hypertension (CTEPH) often develop severe hypoxaemia after pulmonary thromboendarterectomy. There is reluctance to apply high positive end-expiratory pressure (PEEP) to those patients, whereas high PEEP is important for acute hypoxaemic respiratory failure due to alveolar collapse. Open lung approach (OLA) policy, a combination of recruitment manoeuvre and PEEP titration, may improve oxygenation and lung mechanics in acute hypoxaemic respiratory failure, but the effect of OLA on the outcome is unknown. ⋯ In the OLA group, duration of mechanical ventilation was shorter than the conventional treatment group (median, 23.5 hours vs. 43 hours, P = 0.0064). The OLA group showed lower cardiac index, higher pulmonary artery pressure and higher total pulmonary resistance index after the surgery than the conventional group. The introduction of the OLA policy may have shortened mechanical ventilation duration despite what appeared to be less favorable early postoperative hemodynamics in patients after the surgery for CTEPH.
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Anaesth Intensive Care · May 2010
Comparative StudyA comparison of parametric and non-parametric approaches to target-controlled infusion of propofol.
Nineteen adult patients of either gender received intravenous infusions of propofol, scaled to estimated lean body mass (LBM), for 150 minutes as part of a balanced anaesthetic. Arterial blood was assayed for whole blood propofol. The first subject received propofol at a fixed rate of 0.058 mg x min(-1) x kg(LBM)(-1). ⋯ Population pharmacokinetic analysis of the final group of six females and five males, aged 29 to 70 years and of 16.5 to 44.2% body fat, resulted in a two compartment pharmacokinetic model with coefficients and standard errors of V = 0.102 (0.0155) l/kg(LBM), V2 = 0.257 (0.079) l/kg(LBM), k10 = 0.423 (0.069)/min, k12 = 0.222 (0.051)/min, k21 = 0.084 (0.02)/min and clearance = 0.0418 (0.0023) L x min(-1) x kg(LBM)(-1). The only significant covariate was LBM. Within infusion data improved prediction when compared with data derived in previous studies from random observations.