Anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Pain following craniotomy: a preliminary study comparing PCA morphine with intramuscular codeine phosphate.
We have performed a prospective randomised trial of 30 patients undergoing craniotomy to compare intramuscular codeine phosphate with patient-controlled analgesia using morphine 1 mg bolus with a 10-min lockout and no background infusion. For 24 h postoperatively, pain, nausea, Glasgow coma score, respiratory rate and sedation score were assessed. There was a wide variation in the amounts of morphine requested by the patients in the patient-controlled analgesia group in the first 24 h postoperatively (range 2-79 mg, median 17 mg). ⋯ There were no significant differences between the two groups in respect of nausea and vomiting, sedation score or respiratory rate. No major adverse effects were noted in either group. Patient-controlled analgesia with morphine is an alternative to intramuscular codeine phosphate in neurosurgical patients which merits further investigation.
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Randomized Controlled Trial Clinical Trial
The optimal dose of ketamine for caudal epidural blockade in children.
Sixty boys aged up to 9 years undergoing orchidopexy were randomly allocated to receive one of three solutions for caudal epidural injection: group A received 1 ml.kg-1 of 0.25% bupivacaine with 0.25 mg.kg-1 of preservative-free ketamine, group B received 1 ml.kg-1 of 0.25% bupivacaine with ketamine 0.5 mg.kg-1 and group C received 1 ml.kg-1 of 0.25% bupivacaine with 1 mg.kg-1 of ketamine. Postoperative pain was assessed by means of a modified Objective Pain Score and analgesia was administered if this score exceeded four. ⋯ There were no differences between the groups in the incidence of motor block, urinary retention, postoperative vomiting or postoperative sedation. Group C had a significantly higher incidence of behavioural side effects, including slightly odd behaviour, vacant stares and abnormal effect than groups A and B.
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Randomized Controlled Trial Clinical Trial
Pre-operative oral administration of morphine in day-case gynaecological laparoscopy.
The analgesic effect of morphine sulphate 10 mg by mouth given pre-operatively on pain after gynaecological laparoscopy was studied in a randomised, prospective, double-blind, placebo-controlled comparison. Two groups of 56 patients were studied one group undergoing diagnostic laparoscopy and the other laparoscopic sterilisation. ⋯ Morphine premedication did not significantly influence postoperative pain as assessed on a visual analogue scale in either group and postoperative opioid consumption was unaffected. Premedication with morphine 10 mg orally does not significantly decrease pain after day-case gynaecological laparoscopy.
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Randomized Controlled Trial Clinical Trial
Respiratory effects of spinal anaesthesia for caesarean section.
We report the changes observed in a number of pulmonary function tests performed on 36 patients undergoing Caesarean section under spinal anaesthesia. The tests comprised peak expiratory flow, forced expiratory volume in one second, forced vital capacity, forced expiratory volume in one second to forced vital capacity ratio and the maximal mid-expiratory flow. ⋯ These changes persisted for four hours after the induction of spinal anaesthesia. Administration of 35% oxygen by facemask failed to change significantly fetal umbilical vein pH or partial pressure of oxygen.
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Randomized Controlled Trial Clinical Trial
Gas leakage and the laryngeal mask airway. A comparison with the tracheal tube and facemask during spontaneous ventilation using a circle breathing system.
The ability of the laryngeal mask airway, tracheal tube and facemask to provide a leak free seal in a clinical setting was assessed by measuring the minimal fresh gas flows needed in a closed circle system during spontaneous ventilation on 60 subjects. The fresh gas flow was reduced until no spillage occurred from the pop-off valve. This fresh gas flow was taken to represent the sum of gas uptake by the subject and gas leakage from the circuit. ⋯ The fresh gas flow required for the facemask group was significantly higher than that for the laryngeal mask airway or tracheal tube groups (p < 0.01). There was no significant difference between the fresh gas flows required for the tracheal tube and laryngeal mask airway group. We conclude that the laryngeal mask airway provides as good a gas tight seal as a tracheal tube in this context and would be of benefit in reducing anaesthetic gas pollution.