Anaesthesia
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Randomized Controlled Trial Clinical Trial Controlled Clinical Trial
Lumbar epidurography with multi-orifice and single orifice epidural catheters.
The spread of iohexol in the epidural space was studied using two types of epidural catheter. Twenty pre-menopausal women undergoing hysterectomy received lumbar epidural analgesia via either multi-orifice or single orifice catheters. ⋯ Sacral spread of dye was only observed when a single orifice catheter was used. Epidural catheter design affects the distribution of solutions in the epidural space, with single orifice epidural catheters producing more even distribution of dye with sacral extension.
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Randomized Controlled Trial Clinical Trial
Midazolam co-induction and laryngeal mask insertion.
We have studied the effect of alfentanil and midazolam+alfentanil on the conditions for laryngeal mask airway insertion in patients receiving propofol for induction of anaesthesia. Ninety unpremedicated. ⋯ Further boluses of propofol (0.25 mg.kg-1 every 15 s) were given if the initial dose was inadequate for induction of anaesthesia. Patients in the midazolam+alfentanil group required less propofol (p < 0.001), had better mouth opening (p < 0.001) and fewer undesired responses to laryngeal mask airway insertion (p < 0.001) than the other two groups.
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Randomized Controlled Trial Clinical Trial
Lignocaine to aid the insertion of the laryngeal mask airway with thiopentone. A comparison between topical and intravenous administration.
Conditions for insertion of a laryngeal mask airway in 90 unpremedicated adult were patients were assessed in a randomised, single-blinded trial. Each patient received fentanyl 1 microgram.kg-1 and thiopentone 5 mg.kg-1, and this was preceded either by lignocaine 0.5 mg.kg-1 intravenously (group 1), lignocaine 1.5 mg.kg-1 intravenously (group 2) or 40 mg of topical lignocaine spray to the posterior pharyngeal wall (group 3). Conditions for laryngeal mask airway insertion were recorded. ⋯ Overall, the conditions for laryngeal mask airway insertion were better in the topical group (p < 0.05). There were no significant differences in haemodynamic response and apnoea between the three groups. Topical lignocaine spray prior to thiopentone provides conditions for insertion of a laryngeal mask that are superior to those provided by lignocaine and thiopentone intravenously.
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Randomized Controlled Trial Clinical Trial
The prevention of postoperative nausea and vomiting using a combination of ondansetron and droperidol.
We have studied the effect of combination antiemetic therapy (ondansetron and droperidol) with morphine delivered by patient-controlled analgesia following major gynaecological surgery. Sixty patients were randomly allocated to one of three treatment regimens; ondansetron alone (4 mg bolus and 0.13 mg.ml-1 in the morphine solution), droperidol alone (1.25 mg bolus and 0.05 mg.ml-1 in the morphine solution), or both drugs in combination. ⋯ There was no difference between the regimens from 12 to 18 h. We conclude that a combination of ondansetron and droperidol added to morphine in a patient-controlled analgesia system reduces postoperative nausea to a greater extent than treatment with either drug alone following major gynaecological surgery.
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Randomized Controlled Trial Clinical Trial
Lung aeration. The effect of pre-oxygenation and hyperoxygenation during total intravenous anaesthesia.
We have investigated the effect of pre-oxygenation and hyperoxygenation (an increase in inspired oxygen fraction from 0.4 to 1.0 after induction of general anaesthesia) on aeration and atelectasis formation in the lungs during total intravenous anaesthesia. Twenty-seven consecutive patients were randomly allocated to group 1 (with pre-oxygenation), group 2 (without pre-oxygenation), or group 3 (hyperoxygenation). Lung aeration was investigated by means of spiral computed tomography. ⋯ In group 1 larger areas of atelectasis were found in the basal parts of the lungs compared to group 2. In group 3 a significant increase in atelectatic areas with a corresponding reduction in areas with reduced aeration occurred at the bases of the lungs. The considerable increase in atelectasis associated with pre-oxygenation and its rapid appearance during hyperoxygenation suggest that these procedures should be used with caution.