Anaesthesia and intensive care
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Anaesth Intensive Care · Oct 1999
Randomized Controlled Trial Clinical TrialThe effect of single dose intravenous dexamethasone in tonsillectomy in children.
A prospective, randomized, double-blinded, placebo-controlled clinical trial was conducted in 41 patients evaluating the effect of a single preoperative dose of intravenous dexamethasone on postoperative vomiting and pain in children undergoing elective tonsillectomy. Dexamethasone was found to significantly reduce the incidence of vomiting in the first 24 hours postoperatively (P = 0.02), the time to first intake of solids (P = 0.001), the need to administer a rescue antiemetic (P = 0.005) and intravenous fluid therapy requirements (P = 0.006) in the postoperative period. No significant difference was found between the dexamethasone and placebo groups in the time to first intake of fluids, pain scores or analgesic requirement postoperatively. These results indicate that dexamethasone substantially reduces morbidity after tonsillectomy in children.
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Anaesth Intensive Care · Oct 1999
Randomized Controlled Trial Clinical TrialPrevention of postoperative nausea and vomiting in gynaecological laparotomies: a comparison of tropisetron and ondansetron.
In a randomized, double-blind study, the antiemetic efficacy of a single bolus of tropisetron 5 mg (group T, 37 patients), ondansetron 4 mg (group O, 39 patients) or saline (group C, 45 patients) given at induction was compared in a homogeneous group of 121 patients undergoing gynaecological laparotomy and receiving postoperative patient-controlled intravenous morphine for 24 to 48 hours. Fewer group T and group O patients developed severe nausea compared to group C (P < 0.01, log rank test in Kaplan-Meier analysis). ⋯ The overall incidences of severe nausea in groups T, O, and C were 5.4%, 17.9%, and 44.4% respectively (P < 0.001, group T vs group C; P < 0.05 group O vs group C). In conclusion, the 5-hydroxytryptamine 3 receptor antagonists tropisetron and ondansetron were superior to placebo in preventing PONV.
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Anaesth Intensive Care · Aug 1999
Randomized Controlled Trial Comparative Study Clinical TrialPropofol-thiopentone admixture-hypnotic dose, pain on injection and effect on blood pressure.
This study examined some pharmacodynamic characteristics of two admixtures of propofol and thiopentone. Ninety unpremedicated ASA 1 or 2 patients were group-randomized to receive, in a double-blinded manner, one of the following mixtures for induction of anaesthesia: Group P50: propofol 1% 10 ml/thiopentone 2.5% 10 ml; Group P75: propofol 1% 15 ml/thiopentone 2.5% 5 ml; Group P100: propofol 1% 20 ml/lignocaine 1% 4 ml. An additional 30 randomized but unblinded patients from the same patient cohort received thiopentone 2.5% to provide predictive dose data for groups P50 and P75. ⋯ The addition of thiopentone to propofol was found to be as efficacious as the mixing of lignocaine with propofol in reducing pain on injection. The fall in systolic blood pressure was significantly less in group P50 compared with groups P75 or P100. Admixture of thiopentone with propofol results in an additive hypnotic effect, a reduction in pain of injection (comparable with addition of lignocaine) and a reduced hypotensive response compared to propofol injection alone during induction.
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Anaesth Intensive Care · Aug 1999
Randomized Controlled Trial Comparative Study Clinical TrialInduction of anaesthesia in patients with coronary artery disease: a comparison between sevoflurane-remifentanil and fentanyl-etomidate.
In a prospective, randomized study, sevoflurane-remifentanil (Group SR) was compared with fentanyl-etomidate (Group FE) for induction of anaesthesia in patients with ischaemic heart disease. Cardiovascular stability, heart rate, mean arterial pressure, rate pressure product, rescue medications and associated myocardial ischaemia were measured. For Group SR (n = 20), anaesthesia was induced with vital capacity breaths of sevoflurane 5% in oxygen. ⋯ Remifentanil administration was associated with severe bradycardia in three patients and asystole in a fourth. All four patients were on beta-blocking medication and three of the four were on diltiazem. The study was terminated due to the high incidence of bradycardic/asystolic complications in Group SR.
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Anaesth Intensive Care · Aug 1999
Randomized Controlled Trial Comparative Study Clinical TrialThe antiemetic and dysphoric effects of droperidol in the day surgery patient.
The incidence of side-effects of two doses of droperidol used as a prophylactic antiemetic were compared (10 vs 20 micrograms/kg). Two hundred and twenty-eight women for day case laparoscopy were recruited. Pain and nausea scores were collected in the recovery area and in the Day Surgery Unit prior to discharge. ⋯ There were no significant differences between the two groups when nausea scores, incidences of vomiting and pain after discharge were compared. An unexpected finding was the significantly higher incidence of pain in the 10 micrograms/kg group. We conclude that there is no advantage in lowering the dose of droperidol below 20 micrograms/kg in this group of patients.