Anaesthesia
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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.
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Randomized Controlled Trial Comparative Study Clinical Trial
Incidence of intra-operative bradycardia. Comparison of atracurium and vecuronium in gynaecological surgery.
Intra-operative bradycardia is one of the most common cardiac arrhythmias observed in clinical anaesthetic practice and can lead to a potentially dangerous outcome. In a randomised double-blind trial, 50 female patients undergoing elective abdominal hysterectomy were divided into two groups. Group I received atracurium and group II received vecuronium as a neuromuscular blocking agent in a balanced anaesthetic technique. ⋯ The two groups were similar in their demographic characteristics. The results showed that there was no statistically significant difference among the two groups regarding the incidence of simple bradycardia. However, the incidence of severe bradycardia or symptomatic bradycardia requiring treatment was significantly higher in the vecuronium group.
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Randomized Controlled Trial Comparative Study Clinical Trial
The effect of pre-operative administration of bupivacaine compared with its postoperative use.
Eighty patients undergoing lower third molar surgery under general anaesthesia were assigned to one of two groups to receive local anaesthetic blockade either 10 min prior to surgery or after surgery just before leaving the operating theatre. Patients in both groups received the local anaesthetic block whilst unconscious. Pain was assessed using visual analogue scales at 6 h and 1, 3 and 6 days after surgery. ⋯ At no time was it possible to detect any significant difference in pain between the two groups. The administration of local anaesthesia prior to starting surgery does not appear to have any advantage over its postoperative administration in patients undergoing this type of surgery. The local anaesthetic, however, does provide excellent analgesia during the first few hours following surgery.
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Randomized Controlled Trial Multicenter Study Clinical Trial
A comparison of 2% and 1% formulations of propofol for the induction and maintenance of anaesthesia in surgery of moderate duration.
This study, conducted in 110 patients undergoing surgery of moderate duration, compared the pharmacodynamic equivalence, efficacy and safety of 1% and 2% formulations of propofol. Anaesthesia was induced with propofol 2 mg.kg-1 given over 40 s and supplementary bolus injections of propofol were given if needed. There were no significant differences between the groups in mean induction times, total induction doses of propofol, frequency and mean duration of apnoea, fentanyl requirements or mean recovery times (times to eyes opening and to orientation). ⋯ Discomfort on injection occurred in 40% and 52% of those given 1% (n = 55) and 2% (n = 55) propofol, respectively; there was no statistically significant group difference in severity. No major adverse effects were reported. This study showed that the 2% formulation has a similar safety and pharmacodynamic profile to the 1% formulation.