Anaesthesia and intensive care
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Anaesth Intensive Care · Dec 2000
Randomized Controlled Trial Clinical TrialThe prevention of pulmonary aspiration with control of tracheal wall pressure using a silicone cuff.
A prospective open randomized controlled study was performed to assess the ability of Euromedical ILM endotracheal tube cuff (silicone cuff) to prevent pulmonary aspiration. The inflation characteristics of this silicone cuff enables the control of tracheal wall pressure. The silicone cuffed tube was shortened and an adjustable flange was used to convert it to a cuffed tracheostomy tube. ⋯ There were six patients in the Shiley group and six patients in the silicone cuff group. Dye leaked to the trachea in six (100%) of the Shiley group compared with none (0%) of the silicone cuff group (P = 0.001). This study confirms the effectiveness of this silicone cuff at preventing aspiration and the high incidence of leakage with the conventional high-volume low-pressure tracheostomy tube cuff.
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Anaesth Intensive Care · Dec 2000
Randomized Controlled Trial Comparative Study Clinical TrialEffect of short-term ketorolac infusion on recovery following laparoscopic day surgery.
This study tested the hypothesis that, by the addition of parenteral ketorolac to an oral analgesic regimen for one day following laparoscopic surgery, analgesia would be improved and thus the return of normal function hastened. Seventy-two female patients were randomly assigned to receive ketorolac 10.5 mg subcutaneously at the end of surgery followed by a subcutaneous infusion of 1.75 mg/h for 24 to 36 hours, or an equivalent volume of saline. All patients were provided with codeine tablets (30 mg) for analgesia if required. ⋯ Pain scores in the ketorolac group were not significantly lower than in the saline group on the first postoperative day (P = 0.052) and subsequently remained similar. Levels of discomfort on performing six common activities were similar in the two groups over the four-day postoperative period. We conclude that, despite beneficial effects during the period of ketorolac administration, there was no continuing benefit after this time other than reduced analgesic use, and no improvement in the patients' ability to perform common activities.
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Anaesth Intensive Care · Oct 2000
Randomized Controlled Trial Clinical TrialTiming of midazolam and propofol administration for co-induction of anaesthesia.
We aimed to determine the optimum timing of midazolam administration prior to propofol to achieve the maximal reduction in the dose of propofol required to induce anaesthesia. Female (ASA 1-2) patients, aged 18 to 45 years, weighing 40 to 75 kg and scheduled for gynaecological surgery were eligible for the study. Consenting patients were randomly assigned to six groups. ⋯ There was no significant (P = 0.14) difference in propofol ED50 among the five groups which received midazolam. Patients who received midazolam had less recollection of events surrounding induction (P < 0.001) and recalled the induction experience as being more pleasant (P = 0.03) than those who did not receive midazolam. These results indicate that midazolam may be given up to 10 minutes prior to propofol and still achieve a substantial dose reduction.
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Anaesth Intensive Care · Oct 2000
Randomized Controlled Trial Clinical TrialTenoxicam i.v. in major gynaecological surgery--pharmacokinetic, pain relief and haematological effects.
This study compared postoperative analgesic dispensation and measures relating to haemostasis following intravenous administration, in a randomized double-blinded manner, of either placebo or tenoxicam 20 mg to 30 women presenting for major gynaecological oncology surgery under a standardized, combined epidural/general anaesthetic technique. Pharmacokinetic disposition of tenoxicam in this patient cohort was also described. There was no objective or subjective alteration in haemostatic function or increase in blood loss, nor any deviation from the normal range of values. ⋯ There were no significant side-effects and no adverse events attributable to tenoxicam. In this small study we have shown that tenoxicam administered preoperatively reduced the epidural analgesic requirements during the first 48 hours following major gynaecological surgery. There was no clinical or pathological evidence of haematological impairment following a single i.v. administration of tenoxicam 20 mg.
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Anaesth Intensive Care · Oct 2000
Randomized Controlled Trial Clinical TrialThe effect of adding fentanyl to ropivacaine 0.125% on patient-controlled epidural analgesia during labour.
The use of patient-controlled epidural analgesia (PCEA) for labour analgesia is rapidly gaining acceptance. However, the ideal PCEA solution and PCEA program remains uncertain. We studied the effect of adding fentanyl 2 micrograms/ml on demand-only PCEA using ropivacaine 0.125% for labour analgesia. ⋯ The ratio of successful PCEA demand to total number of demands, the satisfaction score and the maternal-fetal outcome were similar in both groups. In conclusion, the addition of fentanyl had a dose-sparing effect on the requirement of ropivacaine. This PCEA regimen produced a low incidence of motor block, good labour pain relief and excellent patient satisfaction.