Anaesthesia
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The long-term survival of elderly patients following critical illness in the United Kingdom has not previously been studied. The demographic (age, sex, diagnosis, severity of illness) and treatment details (admission type, length of treatment, prior surgery) of all critically ill patients aged over 70 years were recorded. The 1-year survival of such patients was measured and compared with that of a matched normal population. ⋯ The 1-year survival of patients aged < 85 years was 56% which was significantly better than that of patients over 85 years (27%). The survival of all critically ill elderly patients was significantly poorer than that of a matched normal population (1-year survival 93%). Logistic regression revealed that age, diagnosis and severity of illness are independent predictors of 1-year survival.
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Randomized Controlled Trial Clinical Trial
The influence of epidural administration of fentanyl infusion on gastric emptying in labour.
The effect of epidural infusions containing fentanyl on maternal gastric emptying in labour was examined using the rate of paracetamol absorption. Women were randomly allocated to receive one of two epidural infusions, bupivacaine 0.125% alone or bupivacaine 0.0625% with fentanyl 2.5 micrograms.ml-1 at a rate of 10-12 ml.h-1. Paracetamol 1.5 g was given orally to women after either 30 ml of the infusion solution had been given (mean time 2.5 h, study A) or 40-50 ml (mean time 4.5 h. study B). ⋯ There were no significant differences in maximum plasma paracetamol concentration, time to maximum paracetamol concentration and area under the concentration-time curve between the two groups for study A. In study B the time to maximum plasma paracetamol concentration was significantly delayed in women receiving > 100 micrograms fentanyl compared with controls (p < 0.05). We conclude that the dose of fentanyl that may delay gastric emptying when given by epidural infusion is greater than 100 micrograms.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of the effects of tramadol and morphine on gastric emptying in man.
In a previous study using an electrical bioimpedance technique and the paracetamol absorption test, we demonstrated that 0.09 mg.kg-1 of morphine delayed gastric emptying in healthy human volunteers. The aim of this study was to investigate whether analgesic doses of tramadol would cause a delay in gastric emptying similar to conventional opioids. Using the same volunteers and techniques as in our previous study, placebo or tramadol (1 mg.kg-1) was given in a randomised, double-blinded, cross-over placebo-controlled study. ⋯ In our previous study, morphine prolonged t0.5 to 21 (3) min (p < 0.03). The maximum concentration and area under the curve of serum paracetamol concentrations following morphine were significantly different from placebo (p < 0.05) and tramadol (p < 0.05). We conclude that tramadol at a dose of 1 mg.kg-1 does not delay gastric emptying in humans.