Anaesthesia and intensive care
-
Anaesth Intensive Care · Apr 1997
Randomized Controlled Trial Comparative Study Clinical TrialComparison of patient-controlled epidural analgesia with patient-controlled intravenous analgesia using pethidine or fentanyl.
We compared patient-controlled epidural analgesia (PCEA) with patient-controlled intravenous analgesia (PCIA) using pethidine or fentanyl in a randomized, double-blind crossover study of 80 patients after caesarean section. Patients received pethidine by PCEA or PCIA, or fentanyl by PCEA or PCIA, with a crossover of the route of administration at 12h. For pethidine, pain scores were lower with PCEA vs PCIA from 4 to 16h (P < 0.05). ⋯ Plasma pethidine was similar between groups. Plasma fentanyl was higher with PCIA vs PCEA at 12h (P = 0.002). PCEA has advantages over PCIA and pethidine may be the preferred drug.
-
Anaesth Intensive Care · Apr 1997
Randomized Controlled Trial Comparative Study Clinical TrialMivacurium in daycase surgical patients.
Laparoscopy is commonly performed as a daycase procedure and requires satisfactory but brief and readily reversible muscle relaxation with good intubating conditions. We have examined the use of the new nondepolarizing muscle relaxant, mivacurium, in this setting and compared it with the two most commonly used such drugs in day surgery, atracurium and vecuronium, in a prospective randomized trial of 107 patients. Mivacurium provided a significantly more rapid onset and briefer duration of muscle relaxation, which was readily reversible with or without pharmacological antagonism.
-
Anaesth Intensive Care · Feb 1997
Randomized Controlled Trial Comparative Study Clinical TrialThe antinociceptive effect of epidural lignocaine and fentanyl during lithotripsy.
To determine the antinociceptive effect of combining epidural fentanyl with lignocaine during non-immersion lithotripsy, 56 healthy patients were enrolled into a prospective, randomized, double-blind study. Epidural anaesthesia was induced with either lignocaine 300 mg alone, or lignocaine 300 mg, or 200 mg in combination with fentanyl 100 micrograms. Throughout the procedure analgesia was assessed by comparing the incidence of (a) spontaneous complaints of pain, (b) patients' attempts to withdraw from the painful stimulus, (c) supplemental epidural lignocaine requirements, (d) the haemodynamic response to lithotripsy and (e) the time to first postoperative pain. ⋯ No difference was found in the time to the first complaint of postoperative pain. Similarly, discharge times were unaffected by treatment modality. We conclude that despite the addition of fentanyl, adequate analgesia during lithotripsy is dependent upon the dose of local anaesthetic administered.
-
Anaesth Intensive Care · Feb 1997
Randomized Controlled Trial Comparative Study Clinical TrialComparison of the efficacy of paracetamol versus paracetamol, codeine and promethazine (Painstop) for premedication and analgesia for myringotomy in children.
This prospective double-blinded study compared the analgesic effectiveness and incidence of complications of a compound preparation Painstop (Paedpharm Pty Ltd) containing paracetamol 12 mg, codeine 0.5 mg and promethazine 0.65 mg per 1.0 ml, dosage 1.0 ml/kg, with paracetamol 20 mg/kg. Ninety-five children aged 1 to 12 years, ASA 1-2, scheduled for myringotomy and drain tuber insertion as a day procedure were randomized to receive Painstop or paracetamol 30 to 60 minutes prior to surgery. Preoperative drowsiness and complications on induction and postoperative sedation, pain and times to achieve goals were recorded. ⋯ There was, however, no difference in times to discharge. Late sedation was more common in the Painstop group (P = 0.03). Pain scores were low and similar in both groups and the need for additional analgesia was uncommon.
-
Anaesth Intensive Care · Feb 1997
Randomized Controlled Trial Comparative Study Clinical TrialA prospective clinical comparison of two intravenous polyurethane cannulae.
Tissue irritation, as evidenced by phlebitis, associated with Optiva (Johnson & Johnson Medical) and Insyte (Becton Dickinson) polyurethane cannulae was studied. The integrity of the cannulae on removal, the incidence of infection at the cannula site and the factors which influence phlebitis were also examined. One thousand and eight patients had a polyurethane cannula placed for induction of anaesthesia for cardiac surgery. ⋯ Minor tip distortion or shaft kinking of the cannulae occurred in 16.2% of Optiva and 23.5% of Insyte. This difference is statistically significant and may relate to the slightly more acute taper at the Optiva cannula tip. Both cannulae were similar in clinical performance.