Anaesthesia and intensive care
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Anaesth Intensive Care · Oct 2000
Randomized Controlled Trial Clinical TrialDoes adrenaline improve epidural bupivacaine and fentanyl analgesia after abdominal surgery?
The alpha-adrenergic agonists have been demonstrated to have synergistic effects with opioids and local anesthetics in animal research. The present study was performed to determine whether the addition of adrenaline improves the analgesic effects of an epidural infusion of a combination of fentanyl and bupivacaine after abdominal surgery. We studied 90 ASA 1 or 2 patients scheduled for abdominal surgery under epidural anaesthesia, with or without general anaesthesia. ⋯ The number of additional analgesics and incidence of side-effects did not differ between groups. In conclusion, the results of the present study demonstrate that the addition of adrenaline to a combination of fentanyl and bupivacaine improves the quality of epidural analgesia after abdominal surgery. Under the conditions of the study, we did not detect any disadvantage from the addition of adrenaline.
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Anaesth Intensive Care · Oct 2000
Randomized Controlled Trial Clinical TrialEffect of pre-incision skin infiltration on post-hysterectomy pain--a double-blind randomized controlled trial.
In this double-blind placebo-controlled randomized trial, we compared the analgesic effect of preoperative 0.25% bupivacaine (n = 21) skin infiltration with normal saline (n = 19) in patients undergoing abdominal hysterectomy through a lower midline incision. All patients received postoperative patient-controlled analgesia with morphine and were followed for 72 hours. The main outcome measures were morphine consumption and pain score at rest, and the contribution of different components of pain was also assessed prospectively. ⋯ Visceral pain predominated in the first 48 hours. We concluded that local anaesthetic infiltration is not effective in reducing pain after abdominal hysterectomy. Effective postoperative analgesia should aim to eliminate the visceral pain component.
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Anaesth Intensive Care · Aug 2000
Randomized Controlled Trial Clinical TrialPre-emptive analgesia with epidural morphine or morphine and bupivacaine.
Studies of preemptive analgesia in humans have shown conflicting results. The study design, patient population and the duration of assessment of postoperative pain are important in the evaluation of preemptive analgesia. We carried out a prospective, randomized, double-blind controlled study in 80 patients of physical status ASA 1-3 undergoing upper abdominal and thoracic surgery. ⋯ Pre MB compared to Pre M had significantly decreased total postoperative morphine requirements (P < 0.0001) and number of top-ups (P < 0.0001). Epidural morphine plus bupivacaine is effective as a preemptive analgesic. Morphine plus bupivacaine has better efficacy than morphine given alone before the induction of anaesthesia.
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Anaesth Intensive Care · Aug 2000
Randomized Controlled Trial Clinical TrialThe intubating laryngeal mask airway: effect of handle elevation on efficacy of seal, fibreoptic position, blind intubation and airway protection.
We conducted three studies to test the hypothesis that elevation of the intubating laryngeal mask (ILM) handle increases efficacy of seal, changes fibreoptic position, prevents aspiration of regurgitated fluid and improves intubation. In study 1, the ILM was inserted into 20 paralysed, anaesthetized patients and 20 cadavers. Oropharyngeal leak pressure and fibreoptic position were measured at an intracuff pressure of 0, 60 and 120 cm H2O with 0, 20 and 40 N of elevation force. ⋯ Aspiration and regurgitation usually occurred at the same oesophageal pressure. In study 3, blind intubation was more successful at 0 N than 40 N (15/20 v 8/20, P = 0.03). We conclude that elevation of the ILM handle has little clinical utility other than as a temporary measure to improve the efficacy of the seal.
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Anaesth Intensive Care · Aug 2000
Randomized Controlled Trial Clinical TrialPostoperative sore throat and hoarseness following tracheal intubation using air or saline to inflate the cuff--a randomized controlled trial.
Sore throat and hoarseness following tracheal intubation is common. The aetiology may include high tracheal cuff pressures. We performed a double-blind, randomized controlled trial in 126 intubated patients to compare the incidence and severity of sore throat and hoarseness following inflation of the cuff using air or saline. ⋯ There was no statistically significant difference between the groups (air 15.9%, saline 14.5%). In the air group mean intra-cuff pressure increased significantly (start 14.0 mmHg, end 40.9 mmHg), while in the saline group there was no significant increase (start 12.7 mmHg, end 14.6 mmHg). The substitution of saline reliably results in sustained low intra-cuff pressures but high tracheal cuff pressure is not an important factor in the development of sore throat or hoarseness postoperatively within the pressure range and duration of operation studied.