Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of regularly dosed oral morphine and on-demand intramuscular morphine in the treatment of postsurgical pain.
A randomized, placebo-controlled, double-blind clinical trial was conducted to compare the use of regularly dosed po morphine and on-demand in morphine in 47 patients undergoing total hip arthroplasty. Patients were randomized to receive either 20 mg (initial dose) of regularly dosed morphine (every four hours po) plus breakthrough pain medication on-demand consisting of both 10 mg morphine po and placebo im, or an equivalent regularly dosed oral placebo (every four hours) with breakthrough pain medication consisting of oral placebo and 5-10 mg morphine im. Subsequent to each request for breakthrough pain medication, the next regularly dosed oral solution was increased by 5 mg (or equivalent volume of placebo) to a maximum of 40 mg po Q4H. ⋯ Fewer patients requested breakthrough pain medication on both days in the oral morphine group. The incidence of nausea and vomiting, and of decreased respiratory rates were similar in both groups. Regularly dosed oral morphine is inexpensive and should be compared to other methods of opioid delivery.
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Randomized Controlled Trial Clinical Trial
Morphine does not affect the awakening concentration of sevoflurane.
This study was designed to determine whether morphine 0.1 mg.kg-1 i.v. given intraoperatively altered the end-tidal concentration of sevoflurane which is associated with eye opening to verbal command. We studied 24 healthy ASA physical status I patients to determine whether morphine, or placebo administered about 60 min before the end of surgery affected recovery from sevoflurane/oxygen anaesthesia. During anaesthesia no other anaesthetics or drugs were given. ⋯ In both groups, the MACawake decreased with age, and the ratio to age-adjusted sevoflurane MAC was 0.31 +/- 0.04 (mean +/- SD) for the control group and 0.30 +/- 0.04 for the morphine group. The ratio had no correlation with age. It is concluded that the awakening concentration of sevoflurane during recovery from anaesthesia is not affected by analgesic doses of morphine 0.1 mg.kg-1 i.v. administered intraoperatively.
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Randomized Controlled Trial Comparative Study Clinical Trial
Patient response to laryngeal mask insertion after induction of anaesthesia with propofol or thiopentone.
The response to insertion of the laryngeal mask airway (LMA) following either propofol 2.5 mg.kg-1 or thiopentone 5 mg.kg-1 was assessed in two groups of patients. The purpose of the study was to ascertain which of these two induction agents provided the better conditions for insertion of the LMA. Anaesthesia was induced by propofol in 35 patients and by thiopentone in 37. ⋯ Thiopentone was associated with an adverse response in 76% of patients, compared with propofol in 26% (P < 0.01). Gagging, laryngospasm and head movement were more common using thiopentone (P < 0.01, P < 0.05 and P < 0.05 respectively) and in 11% (P < 0.05) of the thiopentone group insertion of the LMA was impossible due to inadequate relaxation. We conclude that, using these doses, propofol is superior to thiopentone as an induction agent for insertion of the laryngeal mask airway.
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Intermittent jet ventilation was used during anaesthesia in a 66-yr-old woman who had severe tracheal narrowing secondary to compression by a retrosternal goitre. The trachea was intubated by a small-bore tube, which was placed above the site of narrowing. ⋯ Arterial blood gas analysis during jet ventilation showed PaO2 150 mmHg, PaCO2 35 mmHg and pH 7.4. It is concluded that low-frequency jet ventilation may provide adequate oxygenation and carbon dioxide elimination in the presence of tracheal narrowing.
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Case Reports
Caesarean section and phaeochromocytoma resection in a patient with Von Hippel Lindau disease.
This report describes the anaesthetic management of a women with a term gestation, Von Hippel Lindau disease (VHLD), and a phaeochromocytoma, scheduled for a combined phaeochromocytoma resection and Caesarean section. Von Hippel Lindau disease is characterized by diffuse haemangioblastomas of the central nervous system (CNS) and viscera. It is also associated with phaeochromocytomas and renal cell carcinomas. ⋯ After delivery, opioids (sufentanil 0.4 microgram.kg-1 x hr-1) were used to limit the use of inhalational anaesthesia which may contribute to uterine atony. Postoperative pain was managed with an intravenous narcotic infusion. Both patients had uneventful postoperative courses.