Anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of ondansetron, metoclopramide and placebo as premedicants to reduce nausea and vomiting after major surgery.
In a randomised, double-blind study, we have compared the incidence of postoperative nausea and vomitting in 124 patients undergoing major lower limb orthopaedic surgery following oral premedication with temazapam and ondansetron 8 mg, metoclopramide 10 mg or placebo. They received a standardised epidural and general anaesthetic. An epidural mixture containing bupivacaine 0.1% and fentanyl 10 mg.ml-1 was infused postoperatively. ⋯ The incidence of vomiting significantly decreased from 55% and 43% in the placebo and metoclopramide groups, respectively, to 26% in the ondansetron group (p = 0.03). The incidence of nausea and vomiting in patients who had previously suffered was also significantly reduced from 67% and 68% in the placebo and metoclopramide groups, respectively, to 29% in the ondansetron group (p = 0.035). We conclude that oral premedication with ondansetron 8 mg was superior to metoclopramide 10 mg and placebo in preventing postoperative nausea and vomiting following major orthopaedic surgery in patients given epidural opioid analgesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Co-induction and laryngeal mask insertion. A comparison of thiopentone versus propofol.
Conditions for insertion of the laryngeal mask airway were assessed in 70 unpremedicated patients comparing the co-induction with midazolam-alfentanil-thiopentone and midazolam-alfentanil-propofol. Following pre-induction doses of midazolam 0.04 mg.kg-1 and alfentanil 10 micrograms.kg-1, patients received equipotent doses of either thiopentone or propofol. Whilst jaw relaxation and ease of laryngeal mask insertion were similar between the two groups, patients receiving propofol were less likely to have undesired responses requiring additional boluses of induction agent (p < 0.05). We conclude that, using these doses, propofol is superior to thiopentone for laryngeal mask airway insertion when using a co-induction technique.
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Randomized Controlled Trial Comparative Study Clinical Trial
Analgesia after day case laparoscopic sterilisation. A comparison of tramadol with paracetamol/dextropropoxyphene and paracetamol/codeine combinations.
In a prospective, double-blind trial we compared the analgesic efficacy of tramadol during the first 24 h after day case laparoscopic sterilisation with two commonly prescribed combination analgesics. Seventy-five women were allocated randomly to receive oral paracetamol 325 mg/dextropropoxyphene hydrochloride 32.5 mg, tramadol 50 mg or paracetamol 500 mg/codeine phosphate 30 mg as required after a standardised anaesthetic technique. There were no significant differences in average or worst pain, sleep disturbance, mobility, number of tablets taken, satisfaction or preference for stronger analgesia (26.2% of all patients). ⋯ There was a trend towards a lower incidence of central nervous system side-effects (drowsiness, dizziness, headache) in the paracetamol/codeine group. Tramadol may be considered an alternative analgesic for day case surgery although analgesic regimens of greater efficacy are required for many patients. The relative incidence of side-effects for tramadol and other analgesics requires further evaluation.
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Randomized Controlled Trial Clinical Trial
Reshaping the Macintosh blade using biomechanical modelling. A prospective comparative study in patients.
It has been demonstrated that during routine use of the Macintosh blade, great forces are exerted on the maxillary incisors. The aim of this study was, by using biomechanical modelling, to modify a standard Macintosh blade in order to reduce these forces. ⋯ The mean (SD) maximal forces exerted on the maxillary incisors were 12.7 (8.8) N in patients in the modified Macintosh group compared to 25.5 (17.8) N in the standard Macintosh group (p = 0.008). These results demonstrate that reducing the proximal step of the Macintosh laryngoscope results in a reduction of the forces exerted on the teeth and suggest that laryngoscope blades with a high proximal step might be more traumatic than blades in which the proximal step is reduced.