Anaesthesia and intensive care
-
Anaesth Intensive Care · Feb 1992
Randomized Controlled Trial Comparative Study Clinical TrialPatient-controlled epidural analgesia in labour--is a continuous infusion of benefit?
A randomised, single-blind study was conducted among 52 gravida in active labour, to investigate two variants of patient-controlled epidural analgesia--bolus only versus bolus plus infusion. Patient-controlled analgesia variables, using an epidural solution of 0.125% bupivacaine plus fentanyl 3 mcg per ml, were a 4 ml incremental bolus with 15 minute lockout, plus or minus a 4 ml per hour infusion. ⋯ Both groups had high quality analgesia, low rates of bupivacaine usage and were highly satisfied. However, under the conditions of the study, the addition of a continuous background infusion to self-administration conferred no benefit.
-
Anaesth Intensive Care · Feb 1992
Randomized Controlled Trial Comparative Study Clinical TrialA double-blind randomised trial comparing postoperative analgesia after perioperative loading doses of methadone or morphine.
This double-blind randomised study compared postoperative analgesia after a loading regimen of methadone or morphine in thirty women undergoing abdominal hysterectomy. Methadone or morphine, 0.25 mg.kg-1, was given intravenously at induction of anaesthesia with further increments in the recovery room for analgesia if required. The mean (SD) total doses of methadone and morphine required were 0.43 (0.13) mg.kg-1 and 0.45 (0.15) mg.kg-1 respectively. ⋯ Ten patients in the methadone group did not request any further opioid analgesics while all patients in the morphine group made at least two requests for opioids. The overall postoperative course was remembered as less painful by patients in the methadone group (P less than 0.001). There was no significant respiratory depression or excessive sedation in either group.
-
Anaesth Intensive Care · Feb 1992
Randomized Controlled Trial Comparative Study Clinical TrialComparison of epidural and intravenous opioid analgesia after elective caesarean section.
Patient acceptance is a particularly relevant method of assessing currently employed epidural and intravenous techniques of opioid analgesia after elective caesarean section. We have prospectively studied 71 such patients, randomised postoperatively to receive epidural morphine, intravenous morphine or intravenous pethidine. When compared with either intravenous opioid, epidural morphine provided twofold better average or excellent analgesia with 30% less drowsiness but with about 50% more pruritus. In spite of this troublesome complication, more patients (83% vs 74%) preferred epidural to intravenous opioid analgesia.
-
Anaesth Intensive Care · Feb 1992
ReviewAnaesthesia and the 'inert' gases with special reference to xenon.
Xenon has many of the properties of the ideal anaesthetic agent and has been proposed as a suitable replacement for nitrous oxide in routine clinical anaesthesia. Xenon, krypton and argon are chemically inert under most circumstances, yet all have anaesthetic properties. ⋯ Because of this property, xenon has an important place in the history of the development of theories of anaesthetic action and of concepts such as MAC. Cost is likely to be a major impediment to the regular use of xenon.
-
Anaesth Intensive Care · Feb 1992
Comparative StudyInter-ethnic differences in postoperative pethidine requirements.
A preliminary study of 24 hours' postoperative analgesia using a patient-controlled analgesia technique was undertaken in eight European and fourteen Asian adult patients. All patients had upper abdominal surgery and received weight-related doses of pethidine postoperatively via a Cardiff Palliator. ⋯ The Asian patients made 24% fewer demands for analgesia and had a smaller mean (SD) pethidine consumption, 7.62 (2.04) mg.kg-1, compared with the European patients, 9.97 (2.14) mg.kg-1, (P less than 0.05) during the first 24 hours. Further research is necessary to determine whether the smaller requirement for analgesia in Asian patients is a result of pharmacokinetic or pharmacodynamic differences.