Anaesthesia and intensive care
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Anaesth Intensive Care · Jun 1998
Randomized Controlled Trial Comparative Study Clinical TrialThe effect of intraoperative ventilation strategies on perioperative atelectasis.
Several methods of ventilation have previously been shown to reduce intraoperative atelectasis and alveolar to arterial oxygen gradient (A-a DO2) in healthy patients. This study was designed to show firstly the relative intra-operative benefit and secondly if any method had an effect on atelectasis postoperatively. Using a factorial design we randomized 24 patients to each of the four ventilatory interventions (manual inflations, large tidal volumes, PEEP, and pressure control inverse ratio ventilation (IRV)). ⋯ This study demonstrated that PEEP and IRV were most effective in reducing intraoperative A-a DO2 (P < 0.05 ANCOVA). Using more than one intervention did not improve the A-a DO2. No method had any effect on postoperative A-a DO2.
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Anaesth Intensive Care · Jun 1998
Randomized Controlled Trial Comparative Study Clinical TrialThe effect of forced air warming on postoperative oxygen consumption and temperature in elective orthopaedic surgery.
Actively warming patients during surgery is considered the best method of preventing inadvertent hypothermia. In order to investigate the effect of forced air warming on postoperative oxygen consumption, we studied 26 patients undergoing orthopaedic surgery using a prospective, randomized trial design. ⋯ This study demonstrated the gradual heat gain and also the potential for hyperthermia from pre- and intraoperative forced air warming. We conclude that forced air warming is not necessary for moderate duration non-body-cavity surgery if effective preinduction covering of patients and minimal surgical exposure is achieved.
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Anaesth Intensive Care · Apr 1998
Randomized Controlled Trial Comparative Study Clinical TrialPatient evaluation and comparison of the recovery profile between propofol and thiopentone as induction agents in day surgery.
The patient's subjective perception of the quality of his/her recovery after day case anaesthesia with propofol or thiopentone as induction agents is still controversial. The authors investigated the perception and quality of awakening after anaesthesia during the recovery period and at 24 hours and 72 hours, in outpatients undergoing anaesthesia induced either with propofol or thiopentone and maintained with a volatile anaesthetic. In a double-blind study in adults undergoing knee arthroscopy in a day surgery unit, propofol and thiopentone were compared as induction agents in 60 randomized outpatients. ⋯ In the propofol group, patients awoke more rapidly (9.2 +/- 5.8 vs 12.3 +/- 5.8 min) (P < 0.05); however, the CFFT measurements did not show any significant difference between the groups, except at time = 0 min, when 17 patients in the propofol group were able to perform the test versus only 10 patients in the thiopentone group (P < 0.05). At 4, 24, and 72 hours postoperatively, the authors were unable to detect any difference between the two groups. Except for early recovery, there were no differences between the intermediate and late recovery profiles, when propofol or thiopentone was used as the anaesthetic induction agent in day surgery.
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Anaesth Intensive Care · Apr 1998
Randomized Controlled Trial Clinical TrialSubcutaneous tunnelling of epidural catheters for postoperative analgesia to prevent accidental dislodgement: a randomized controlled trial.
The use of subcutaneous tunnelling to prevent movement of epidural catheters was examined in a prospective controlled trial. There were 113 patients in the standard group and 100 in the tunnelled group. The groups were similar with respect to age, sex and weight. ⋯ In total, 60 catheters moved significantly from their initial position: 17 (28%) moved inwards and 43 (72%) moved outwards. 159 catheters were still functioning at the time of their removal, 76 standard and 83 tunnelled. This represents 67 and 83% of the two groups respectively. Subcutaneous tunnelling was shown to prevent clinically significant inwards (P = 0.043) and outwards (P = 0.0005) movement of epidural catheters and is more likely to result in a functional epidural blockade at the time of catheter removal (P = 0.0084).
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Anaesth Intensive Care · Feb 1998
Randomized Controlled Trial Clinical TrialIntravenous tenoxicam for analgesia following laparoscopic cholecystectomy.
In a double-blind, placebo-controlled clinical trial (power of 80% to detect a 30% reduction in morphine consumption, P < 0.05) we have determined that intraoperative intravenous administration of tenoxicam 40 mg during laparoscopic cholecystectomy, when compared with placebo, was associated with a significant reduction in consumption of morphine at 6 hours and 12 hours (P < 0.05) but not at 24 hours, when assessed by patient-controlled analgesia. Furthermore there was a significantly greater requirement for "rescue" analgesia with intramuscular morphine in the placebo group during the period of the study. There was no difference between the groups in pain scores, either at rest or on movement, nor in the incidence of nausea and vomiting. No patient in either group suffered a respiratory rate less than 8/min or oversedation at any time, and there were no other adverse effects.