Anaesthesia and intensive care
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Anaesth Intensive Care · Nov 2013
Randomized Controlled Trial Comparative StudyA comparison between total intravenous anaesthesia using propofol plus remifentanil and volatile induction/ maintenance of anaesthesia using sevoflurane in children undergoing flexible fibreoptic bronchoscopy.
Flexible fibreoptic bronchoscopy is an important tool in the evaluation and management of paediatric respiratory disease. Total intravenous anaesthesia (TIVA) and volatile agent induction and maintenance of anaesthesia (VIMA) are commonly used for these procedures. The aim of this study was to determine which is superior for children undergoing flexible fibreoptic bronchoscopy. ⋯ Agitation and coughing also occurred less frequently in the TIVA group. In addition, physicians' levels of satisfaction were greater in the TIVA group. Our results suggest that TIVA with propofol plus remifentanil is superior to VIMA using sevoflurane alone for children undergoing flexible fibreoptic bronchoscopy.
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Anaesth Intensive Care · Sep 2013
Randomized Controlled TrialDuration of cortisol suppression following a single dose of dexamethasone in healthy volunteers: a randomised double-blind placebo-controlled trial.
The synthetic glucocorticoid dexamethasone is administered to many patients receiving a general anaesthetic to reduce the risk of postoperative nausea and vomiting. Dexamethasone is known to suppress the hypothalamic-pituitary-adrenal axis; however, the duration of this suppression following the standard anti-emetic intravenous dose of 4 to 8 mg used with anaesthesia is unknown. A randomised controlled double-blind crossover trial assessing the effects of 8 mg intravenous dexamethasone versus saline control was performed in ten healthy male volunteers. ⋯ Increased plasma glucose levels were also observed in the dexamethasone group as compared with placebo. A dose of 8 mg of dexamethasone results in significant suppression of the hypothalamic-pituitary-adrenal axis and elevated plasma glucose levels. The cortisol suppression is maximal at approximately 24 hours post dose.
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Anaesth Intensive Care · Jul 2013
Randomized Controlled TrialEffect of alkalinisation of lignocaine for propofol injection pain: a prospective, randomised, double-blind study.
The aim of this study was to determine whether pretreatment with alkalinised lignocaine reduced the incidence and severity of pain during propofol injection. This prospective, randomised, double-blind study included 300 adult, American Society of Anesthesiologists physcial status I to II patients undergoing elective surgery. Patients were randomly allocated to one of three groups: Group L received 0.05 ml/kg of 1% lignocaine (5 ml normal saline + 5 ml 2% lignocaine), Group A received 0.05 ml/kg alkalinised lignocaine (5 ml 2% lignocaine + 1 ml 8.4% NaHCO3 + 4 ml normal saline), and Group S, the control group, was given the same amount of normal saline (NaCl 0.9%). ⋯ In addition, the pain score and the incidence of pain were found to be significantly different between Group L and Group S (P <0.001). The incidence of moderate and severe pain were greater in Group S when compared with groups A and L (P <0.001). Intravenous pretreatment with alkalinised lignocaine appears to be effective in reducing the pain during propofol injection.
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Anaesth Intensive Care · Jul 2013
Randomized Controlled Trial Comparative StudyEpidural versus continuous transversus abdominis plane catheter technique for postoperative analgesia after abdominal surgery.
Transversus abdominis plane block is an effective postoperative analgesic technique after abdominal surgery, but no study has compared continuous transversus abdominis plane block with continuous epidural analgesia. We designed a randomised controlled trial comparing these techniques for major abdominal surgery. Patients in the epidural group received a bolus of 8 to 15 ml of ropivacaine 0.2% and an infusion of 5 to 15 ml/hour and the transversus abdominis plane block group a bolus dose of 20 ml of ropivacaine 0.375% bilaterally and an infusion of 0.2% ropivacaine 8 ml/hour bilaterally, for three days. ⋯ No differences were found in regards to point pain scores or scores over time, either immediately postoperatively or in surgical wards; total fentanyl requirement and Likert satisfaction scores were also similar in both groups. In this underpowered study we found comparable results between continuous transversus abdominis plane technique and epidural analgesia in regard to pain, analgesic use and satisfaction after abdominal surgery. To confirm this finding, randomised trials with larger numbers of participants are needed.
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Anaesth Intensive Care · May 2013
Randomized Controlled TrialEffects of dexmedetomidine infusion on laryngeal mask airway removal and postoperative recovery in children anaesthetised with sevoflurane.
We investigated the effects of dexmedetomidine infusion on the end-tidal concentration of sevoflurane required for smooth removal of the laryngeal mask airway (LMA) and on the incidence of respiratory complications during postoperative recovery in paediatric patients anaesthetised with sevoflurane. Eighty-seven patients (ASA 1 or 2, aged 3-7 years) were randomly allocated to receive saline (Group C), 0.5 µg/kg dexmedetomidine (Group D(1)), or 1 µg/kg dexmedetomidine (Group D(2)) after LMA insertion. A predetermined end-tidal sevoflurane concentration for each patient was determined using the Dixon's up-and-down method (starting at 2.2% and step was 0.2%). ⋯ The incidence of breath-holding was significantly lower in Group D(2) (3%) than in Group C (27%; P=0.009), but comparable between Groups D(1) (17%) and C (P=0.385). The incidence of severe coughing was significantly lower in Groups D(1) (14%) and D(2) (6%) as compared to Group C (39%; P=0.005), but comparable between Groups D(1) and D(2) (P=0.323). In conclusion, dexmedetomidine infusion produced a dose-dependent decrease in the end-tidal concentration of sevoflurane required for smooth LMA removal in children and was associated less agitation in the post-anaesthetic care unit.