Canadian journal of anaesthesia = Journal canadien d'anesthésie
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A case is described of a 54-year-old 55 kg patient who presented for clipping of a middle cerebral aneurysm two years after a successful renal allograft. Immunosuppression was maintained with azathioprine 100 mg daily, cyclosporine 300 mg daily and prednisone 10 mg daily. The patient had chronic hypertension controlled with nifedipine 40 mg daily and furosemide 20 mg daily. ⋯ The patient was re-intubated. It is proposed that cyclosporine potentiated the pancuronium blockade producing prolonged neuromuscular relaxation resulting in residual paralysis following surgery. The potential interactions of cyclosporine and muscle relaxants deserve further study.
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Comparative Study Clinical Trial Controlled Clinical Trial
Pharmacokinetics and clinical efficacy of intrarectal solution of acetaminophen.
Acetaminophen is frequently administered orally to children for its analgesic properties, although its potency has never been clearly evaluated in this population. In certain situations (patients vomiting or unconscious), acetaminophen has to be given rectally. However, the rectal absorption of suppositories is frequently erratic. ⋯ The absorption of acetaminophen was incomplete (peak serum concentration: 70.8 mumol. L-1) and delayed. We conclude that the rectal administration of acetaminophen at the induction of anesthesia results in incomplete and delayed absorption and does not prevent the occurrence of immediate postoperative pain in children undergoing adeno-tonsillectomy.
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Clinical Trial Controlled Clinical Trial
Naloxone infusion after prophylactic epidural morphine: effects on incidence of postoperative side-effects and quality of analgesia.
There have been conflicting reports of the value of naloxone infusions to prevent the side-effects associated with epidural morphine. In our study, 29 patients undergoing thoracotomies for pulmonary surgery received epidural morphine (0.1 mg.kg-1) shortly after induction of anaesthesia. ⋯ In addition, side-effects occurred in all groups. We conclude that prophylactic naloxone, used in this manner, is not an appropriate technique for the prevention of side-effects associated with epidural morphine used for the prevention of pain after thoracotomy.
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Randomized Controlled Trial Clinical Trial
Intravenous meperidine for control of shivering during caesarean section under epidural anaesthesia.
To determine the efficacy of meperidine in controlling shivering during epidural anaesthesia for Caesarean section, forty-six parturients were studied. After delivery of the infant, shivering patients received either a single dose of intravenous meperidine 50 mg, or saline in a randomized double-blind fashion. Shivering was classified on a scale of 0 to 3 (grade 0 = none, grade 3 = severe shivering that was distressing to the patient and interfered with monitoring). ⋯ The incidence of nausea was similar, although patients receiving meperidine were more drowsy at two and five minutes following injection (p less than 0.01) compared with patients in the saline group. There were no differences in level of consciousness at the later intervals. The mechanism of action of meperidine on shivering remains to be elucidated.