Anaesthesia
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This study was conducted to investigate the effect of voluntary tetanus on the recovery from neuromuscular block produced by a nondepolarising drug, vecuronium, in the isolated forearm. We have studied the recovery indices and train of four fade at different levels of recovery following vecuronium in both isolated forearms simultaneously, in six sets of experiments. In one hand the volunteer performed a maximum contraction of his thumb repeatedly at fixed intervals. ⋯ The train-of-four fade also showed a sustained reduction in the isolated forearm which underwent voluntary tetanus. During the later phase of recovery the train-of-four fade showed significant difference statistically (p < 0.01). The findings of this study supports the hypothesis that more rapid recovery associated with voluntary tetanus is due to a reduction in the presynaptic block thus resulting in an increased rate of transmitter release.
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We questioned 50 anaesthetic staff about the costs of consumables used in routine anaesthetic practice. By means of a questionnaire staff were asked for estimates of the cost of 28 drugs, fluids and disposables. The responses were more accurate than in previous surveys; 47% of all the estimated costs were within 50% of the actual costs and 75% were within 100%. ⋯ However, allowing for inflation, the cost today is actually equivalent to the cost in 1959. Since 1980 there has been no consistent pattern in drug prices, with some prices remaining the same, others falling and some increasing; all are, however, cheaper in real terms. It is possible to make substantial savings by using the more expensive drugs judiciously and by encouraging the use of low-flow, closed-circuit anaesthetic systems.
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Randomized Controlled Trial Comparative Study Clinical Trial
Epidural infusions for nulliparous women in labour. A randomised double-blind comparison of fentanyl/bupivacaine and sufentanil/bupivacaine.
Sixty nulliparous women received epidural infusions in labour of 0.0625% bupivacaine containing either 2.5 micrograms.ml-1 of fentanyl or 0.25 micrograms.ml-1 of sufentanil, each starting at 12 ml.h-1. The duration of each stage of labour did not differ significantly between the groups nor did the mode of delivery. The quality of analgesia in the first and second stages of labour and at delivery was similar in the two groups and there were no significant differences in the bupivacaine dose requirements. ⋯ There were no significant differences in Apgar scores, umbilical cord blood pH levels or neurologic and adaptive capacity scores at 2 or 24 h. Satisfaction with first and second stage analgesia was high with no differences between the groups. There were no significant differences in the incidence of postnatal symptoms with 52% of women reporting perineal pain and 45% localised backache.
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Randomized Controlled Trial Clinical Trial
Addition of droperidol to patient-controlled analgesia: effect on nausea and vomiting.
A double-blind trial of the effect of droperidol on the incidence of nausea and vomiting in patients using patient-controlled analgesia was carried out in 60 healthy women undergoing abdominal hysterectomy. After a standard anaesthetic including droperidol 2.5 mg as a prophylactic antiemetic, patients were randomly allocated to receive postoperative patient-controlled analgesia with either morphine alone (2 mg.ml-1) or morphine (2 mg.ml-1) with droperidol (0.2 mg.ml-1) added to the syringe. Verbal scores and visual analogue scores for nausea, vomiting, pain and sedation were made at 4, 12 and 24 h postoperatively, and any requirement for intramuscular prochlorperazine noted. ⋯ At 12 h, patients receiving droperidol experienced significantly less nausea, and over the first 24 h, 31% required prochlorperazine compared with 59.3% of patients not receiving droperidol. The number of patients with sedation at 24 h was significantly greater in the droperidol group. We conclude that the addition of droperidol to morphine both reduces nausea and the need for further antiemetic treatment.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison between mivacurium and suxamethonium in children.
The neuromuscular effects of mivacurium were compared with those of suxamethonium in 69 children (aged 2-12 years), during nitrous oxide, oxygen and halothane anaesthesia in a randomised open study. Neuromuscular block was monitored by measuring the acceleration of the thumb caused by contraction of the adductor pollicis muscle after supramaximal stimulation of the ulnar nerve at the wrist using an Accelograph. End-tidal carbon dioxide was maintained at about 4 kPa in both groups. ⋯ The range of maximum block was similar for both drugs. The average time to reach maximum block was 143 s for mivacurium and 56 s for suxamethonium. Intubating conditions were similar in the two groups.