Anaesthesia and intensive care
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Anaesth Intensive Care · Oct 1998
Randomized Controlled Trial Clinical TrialClosed circuit anaesthesia in ventilated patients using the Komesaroff vaporizer within the circle.
A study was undertaken to assess the performance of the Komesaroff vaporizer, placed within the circuit, in ventilated patients during maintenance of closed circuit anaesthesia with halothane or isoflurane. Following intravenous induction, anaesthesia was maintained by inhalation. This was achieved using a conventional vaporizer outside the circle for the first 10 minutes to manage the fast uptake phase. ⋯ The Komesaroff vaporizer dial was positioned at between the first and second division and end-tidal volatile anaesthetic agent levels were measured. This study demonstrated that at dial positions 1 or 1.5 with either agent, the end-tidal volatile concentration plateaued at clinically acceptable levels. The Komesaroff vaporizer can therefore be used safely in ventilated patients to maintain closed circuit anaesthesia provided clinical observation and monitoring are meticulous.
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Anaesth Intensive Care · Oct 1998
Randomized Controlled Trial Multicenter Study Clinical TrialA comparison of 0.5% ropivacaine and 0.5% bupivacaine for axillary brachial plexus anaesthesia.
The purpose of this study was to compare the use of 0.5% ropivacaine with 0.5% bupivacaine for axillary brachial plexus anaesthesia. Sixty-six patients undergoing upper limb surgery were enrolled in a double-blind, randomized, multicentre trial. Five patients were subsequently excluded for various reasons. ⋯ These parameters were not statistically different. The duration of partial motor block at the wrist (6.8 v 16.4h) and hand (6.7 v 12.3h) was significantly longer with bupivacaine. Ropivacaine 0.5% and bupivacaine 0.5% appeared equally efficacious as long-acting local anaesthetics for axillary brachial plexus block.
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Anaesth Intensive Care · Oct 1998
Randomized Controlled Trial Clinical TrialMivacurium compared with three different doses of suxamethonium for nasotracheal intubation.
Suxamethonium in the doses of 1.0, 0.5 and 0.25 mg/kg was compared with mivacurium 0.15 mg/kg in 80 patients requiring nasotracheal intubation for maxillofacial surgery in a double-blind randomized controlled trial. Anaesthesia was induced with thiopentone 5 mg/kg and alfentanil 15 micrograms/kg. Patients were randomly allocated to one of the four relaxant groups. ⋯ Significantly fewer patients given suxamethonium 0.5 mg or 0.25 mg/kg had acceptable intubating conditions (90% and 70% respectively) (P = 0.003). Poor intubating conditions requiring additional relaxation were seen in two patients given suxamethonium 0.25 mg/kg and two given 0.5 mg/kg, while no patients given suxamethonium 1.0 mg/kg or mivacurium 0.15 mg/kg required additional relaxation (P = 0.004). Only four patients had postoperative myalgia, all of whom were given suxamethonium 0.5 mg/kg or more but no significant difference between groups could be demonstrated.
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Anaesth Intensive Care · Oct 1998
Randomized Controlled Trial Clinical TrialA comparison of three fluid-vasopressor regimens used to prevent hypotension during subarachnoid anaesthesia in the elderly.
We aimed to compare the efficacy of fluid preloading with two recently recommended fluid-vasopressor regimens for maintaining blood pressure during subarachnoid anaesthesia in the elderly. Sixty elderly patients requiring surgery for traumatic hip fractures received subarachnoid anaesthesia using 0.05 ml/kg of 0.5% heavy bupivacaine. Hypotension, i.e. systolic arterial pressure < 75% of baseline, was prevented or treated by: A--normal saline 16 ml/kg plus intravenous ephedrine boluses (0.1 mg/kg); B--normal saline 8 ml/kg plus intramuscular depot ephedrine (0.5 mg/kg); or C--Haemaccel 8 ml/kg plus metaraminol infusion. ⋯ During the first hour, hypotension was present for 47%, 25% and 20% of the time in groups A, B and C respectively and overcorrection of systolic arterial pressure occurred in 19% of the time in group C. We conclude that treatment A was inadequate in preventing hypotension. Treatments B and C were more effective but were associated with an increased heart rate and overcorrection of systolic arterial pressure respectively.
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Anaesth Intensive Care · Aug 1998
Randomized Controlled Trial Clinical TrialLack of efficacy of propofol in the treatment of early postoperative nausea and vomiting.
The anti-nauseant efficacy of low-dose propofol was investigated in a blinded, randomized trial. Patients who complained of nausea and/or vomiting following laparoscopic gynaecological surgery and who requested antiemetic were randomly assigned to receive placebo, propofol 3 mg, propofol 9 mg or propofol 27 mg by intravenous injection. Nausea, vomiting and sedation were recorded by a blinded observer for 90 minutes following administration of the test drug, prior to discharge, and 24 hours following surgery. ⋯ Numbers of patients receiving rescue antiemetic were similar in the four treatment groups. In the first 10 minutes following test drug administration, sedation scores were increased by propofol in a dose-related manner. We conclude that, in the dose range studied, propofol is ineffective for the treatment of nausea and vomiting occurring soon after laparoscopic gynaecological surgery.