Anaesthesia and intensive care
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Anaesth Intensive Care · Oct 1994
Randomized Controlled Trial Comparative Study Clinical TrialHigh-dose aprotinin in cardiac surgery--a prospective, randomized study.
Fifty patients undergoing primary coronary artery bypass surgery and 50 patients undergoing valve surgery received either high-dose aprotinin (2 million units loading dose, 2 million units added to the CPB prime, and 500,000 units/hr maintenance infusion) or placebo. Mean postoperative blood loss in the first six hours was reduced from 321 ml in the placebo group to 172 ml in the aprotinin group (95% confidence interval (CI) for difference = 95 to 189 ml). Seven patients in the placebo group and 16 patients in the aprotinin group did not require transfusion with homologous blood. This study adds to the growing body of evidence that the administration of high-dose aprotinin reduces blood loss and blood transfusion requirements associated with primary cardiac surgery.
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Anaesth Intensive Care · Oct 1994
Randomized Controlled Trial Comparative Study Clinical TrialA double-blind comparison of vecuronium administered by the Springfusor infusion device to vecuronium by intermittent bolus injection in critically ill adult patients.
To evaluate the Springfusor infusion device for clinical use in an Intensive Care Unit and to compare the technique of intermittent bolus and constant infusion of muscle relaxants, we undertook a prospective double-blind randomized placebo-controlled study. Twenty critically ill ventilated patients requiring muscle paralysis were investigated. ⋯ The device is robust, easy to use and reduces nursing workload. This may translate into cost-saving improvement in patient care if the Springfusor is used to provide muscle relaxation, sedation and analgesia.
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Anaesth Intensive Care · Oct 1994
Randomized Controlled Trial Comparative Study Clinical TrialPatient-controlled analgesia: a comparison with nurse-controlled intravenous opioid infusions.
Patient-controlled analgesia (PCA) with intravenous pethidine was compared with nurse-controlled pethidine infusions for pain relief in 200 patients after major abdominal or thoracic surgery. Pain, level of sedation, nausea and presence of other adverse effects, in addition to cumulative pethidine requirement, were measured for the first 24 hours after surgery. Both groups were similar for age, weight and type of surgery. ⋯ The frequency and severity of adverse effects was also similar. The cumulative pethidine dose administered to both groups was identical. It is concluded that nurse-controlled opioid infusions are as effective as PCA and may be used as an alternative to PCA where this is either unavailable or unsuitable.
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Anaesth Intensive Care · Oct 1994
Randomized Controlled Trial Comparative Study Clinical TrialPropofol injection pain: comparing the addition of lignocaine or metoclopramide.
Lignocaine has been shown to reduce the incidence of pain on injection of propofol. Metoclopramide, a weak local anaesthetic and commonly used antiemetic, was combined with propofol and the mixture compared, in a prospective, randomized trial, with a lignocaine-propofol combination. ⋯ One patient in the metoclopramide-propofol group had a minor extrapyramidal reaction. No adverse local or haemodynamic effects were seen.
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Anaesth Intensive Care · Oct 1994
Randomized Controlled Trial Comparative Study Clinical TrialA comparison of three induction agents in paediatric anaesthesia--cardiovascular effects and recovery.
We studied 30 children undergoing circumcision randomly allocated to receive either thiopentone 4 mg.kg-1, propofol 2.5 mg.kg-1 or midazolam 0.5 mg.kg-1 (n = 10) IV over 30 seconds at induction of anaesthesia. Blood pressure and pulse rate during the first 15 minutes of induction were recorded by a Finapres 2300e and a Cardiocap CM-104, and changes from preinduction baseline compared between the three induction agents and the two recording instruments. Postoperatively, blood levels of the induction agents were measured and recovery from anaesthesia was assessed by clinical criteria, mood and sedation scores and psychomotor performance. ⋯ Drug blood levels correlated weakly with both methods of psychomotor assessment (r > or = 0.6). Of the three induction agents, thiopentone caused the least haemodynamic perturbation on induction, and anaesthesia induced with midazolam caused the greatest psychomotor impairment on awakening. Within one hour patients in all drug groups were equally awake, co-operative and co-ordinated.