Anaesthesia and intensive care
-
Anaesth Intensive Care · Oct 1996
Randomized Controlled Trial Comparative Study Clinical TrialThe prophylactic antiemetic efficacy of prochlorperazine and ondansetron in nasal septal surgery: a randomized double-blind comparison.
A prospective, randomized placebo-controlled study was undertaken to compare the effects on heart rate and blood pressure during surgery and on the incidence of nausea, vomiting and headache after surgery of i.m. prochlorperazine 0.2 mg.kg-1, i.v. prochlorperazine 0.1 mg.kg-1 and i.v. ondansetron 0.06 mg.kg-1 given at induction of general anaesthesia to patients undergoing septorhinoplasty. The effects of the test drugs after administration on heart rate and blood pressure were similar, as were the incidences of retching and vomiting in the recovery ward after each test drug. Postoperatively, compared with placebo (7%), nausea per se was most frequent in those given i.v. prochlorperazine (25%, P < 0.01), and less frequent in those given i.m. prochlorperazine (2%) and i.v. ondansetron (15%). ⋯ I.m. prochlorperazine and i.v. ondansetron increased the frequency (from 35% to 64%, P < 0.0005 and to 71%, P < 0.0005, respectively) of those experiencing no PONV and delayed the onset of PONV, but only i.m. prochlorperazine reduced the severity of postoperative vomiting. Headache was frequent in the control (69%), i.v. prochlorperazine (62%) and i.v. ondansetron (69%) groups, and least frequent after i.m. prochlorperazine (53%; P < 0.05 versus i.v. ondansetron). It is concluded that these drugs have no adverse cardiovascular effects within 10 minutes of administration, i.m. prochlorperazine and i.v. ondansetron reduce PONV more effectively than i.v. prochlorperazine and postoperative headache after septorhinoplasty occurs less frequently in those given i.m. prochlorperazine than in those given i.v. ondansetron.
-
Anaesth Intensive Care · Oct 1996
Randomized Controlled Trial Comparative Study Clinical TrialA randomized double-blinded comparison of metoclopramide, ondansetron and cyclizine in day-case laparoscopy.
This study determined the overall incidence of postoperative nausea and vomiting (PONV) in 38 patients undergoing laparoscopic gynaecological procedures who received a standardized propofol/isoflurane anaesthetic but no preoperative antiemetic. A further 166 patients similarly anaesthetized were then randomly allocated to receive either metoclopramide 10 mg. ondansetron 4 mg, or cyclizine 50 mg as an intravenous antiemetic immediately preinduction. Overall incidence of PONV was determined for all groups and the relative efficacy of the three antiemetic agents assessed. ⋯ There was no detectable difference in relative efficacy between ondansetron 4 mg and metoclopramide 10 mg. The incidence of PONV in the group who received cyclizine was similar to that found in the pilot group who received no PONV prophylaxis. Both metoclopramide and ondansetron may potentially decrease the incidence of PONV following gynaecologic laparoscopy by up to 50% when administered intravenously prior to a propofol/isoflurane anaesthetic.
-
Anaesth Intensive Care · Oct 1996
Randomized Controlled Trial Clinical TrialProphylactic administration of histamine 1 and/or histamine 2 receptor blockers in the prevention of heparin- and protamine-related haemodynamic effects.
The efficacy of prophylactic administration of H1 and H2 receptor blockers to prevent adverse haemodynamic responses to heparin and protamine was studied. The control group (n = 10) received no histamine receptor blocker, group H1 (n = 10) received oral terfenadine 60 mg, group H2 (n = 10) received oral ranitidine 300 mg, and group H1+H2 (n = 10) received both terfenadine and ranitidine on the night before the operation and on call to the operating room. Heparin sulphate 300 U/kg was injected directly into the right atrium, and protamine hydrochloride was administered at the conclusion of bypass over at least three minutes through a peripheral route. ⋯ Protamine infusion did not lead to an increase in H-LA. Prophylactic administration of histamine receptor blockers (H1 or H2) attenuated the heparin-induced adverse haemodynamic response but did not change the protamine-related haemodynamic effects. Factors other than histamine may play a major role in protamine induced cardiovascular changes.
-
Anaesth Intensive Care · Oct 1996
Randomized Controlled Trial Clinical TrialRecovery from mivacurium block with or without anticholinesterase following continuous infusion in obstetric patients.
Neostigmine antagonism after suxamethonium followed by mivacurium chloride bolus and infusion was studied. Thirty ASA group I or II patients were given mivacurium 0.15 mg/kg followed by infusion during nitrous oxide-enflurane-pethidine anaesthesia. Train of four (TOF) stimuli were applied to the ulnar nerve at the wrist and TOF twitch height and ratio measured by TOF-GUARD nerve stimulator. ⋯ There were significant differences in the time taken to TOFR of 25% (P < 0.0001) and 50% (P < 0.05) but no difference in the time taken for TOFR to return to 70%. We concluded that mivacurium is suitable for use in caesarean section despite a decrease in plasma cholinesterase activity. Neostigmine antagonism is not required as a routine.
-
Anaesth Intensive Care · Jun 1996
Randomized Controlled Trial Comparative Study Clinical TrialThe application of EMLA and glyceryl trinitrate ointment prior to venepuncture.
The efficacy of EMLA cream combined with glyceryl trinitrate (GTN) ointment was assessed by a double-blind prospective study. Adult female patients were randomly allocated to receive either EMLA 1 ml or 2 ml combined with GTN 2 mg, or EMLA 2 ml only. ⋯ There were no significant side-effects. It is concluded that if GTN is used with EMLA, the dose of EMLA can be reduced and intravenous cannulation is technically easier compared with EMLA alone.