Anaesthesia
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Randomized Controlled Trial Clinical Trial
A prospective randomised controlled study of patient-controlled propofol sedation in phobic dental patients.
The safety and effectiveness of patient-controlled propofol sedation was prospectively assessed in 18 healthy, phobic dental patients. Using a randomised, crossover design each patient received two sessions of equivalent dental treatment under patient-controlled or clinician-controlled propofol sedation. The patient-controlled technique used 29.8% less drug (time-weighted dose) than the clinician-controlled method (p = 0.011). ⋯ Patient-controlled sedation produced a greater reduction in dental and general anxiety compared with clinician-controlled sedation, but the difference did not reach statistical significance. Three times the number of patients expressed a preference for the patient-controlled, compared with the clinician-controlled, technique. Patient-controlled sedation provides safe and acceptable intra-operative anxiolysis for phobic dental patients, but with reduced propofol dosage.
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Randomized Controlled Trial Comparative Study Clinical Trial
Randomised double-blind comparison of fentanyl, mivacurium or placebo to facilitate laryngeal mask airway insertion.
In a double-blind randomised study, we compared conditions during insertion of the laryngeal mask airway in 150 patients who received either fentanyl 1 microg.kg-1, mivacurium 0.04 mg.kg-1 or normal saline, before induction of anaesthesia with propofol 2 mg.kg-1. Insertion conditions, including mouth opening, swallowing, gagging or coughing, head or limb movement and ease of insertion, were each graded using a three-point scale. ⋯ Insertion conditions were similar between fentanyl and mivacurium, while both prolonged apnoea. Fentanyl and mivacurium are equally effective in facilitating insertion of the laryngeal mask airway following anaesthetic induction with propofol.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Postoperative pain control following remifentanil-based anaesthesia for major abdominal surgery.
Eighty patients undergoing major abdominal surgery using remifentanil-based anaesthesia were randomly allocated in a double-blind manner to receive an intravenous bolus of fentanyl, buprenorphine, morphine or piritramide 20 min before the end of surgery. A reduced dose was administered postoperatively when patients reported moderate pain. Subsequent analgesia was provided by patient-controlled analgesia (PCA). ⋯ At first pain assessment, 63% of patients reported no or mild pain; 80% of patients required the second opioid bolus, those receiving piritramide needed the bolus significantly later than patients receiving buprenorphine or fentanyl. First PCA requirement also occurred significantly later in the piritramide group. This technique provided effective postoperative pain relief and transition to routine PCA and did not compromise recovery.
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Randomized Controlled Trial Comparative Study Clinical Trial
Emergence characteristics and postoperative laryngopharyngeal morbidity with the laryngeal mask airway: a comparison of high versus low initial cuff volume.
In this study we tested the hypothesis that the initial cuff volume of the laryngeal mask airway influences emergence characteristics and postoperative laryngopharyngeal morbidity. One hundred and sixty adult patients undergoing minor surgery were randomly assigned for airway management with the laryngeal mask airway with either a fully inflated cuff (LMA-High) or a semi-inflated cuff (LMA-Low). Anaesthesia was with propofol, nitrous oxide, oxygen and isoflurane. ⋯ Heart rate was slightly higher in the LMA-High group upon arrival in the postanaesthesia care unit, but otherwise there were no differences in cardiorespiratory responses. Sore throat and dysphagia were more common in the LMA-High group. We conclude that, in general, emergence characteristics with the laryngeal mask airway are not influenced by the volume of air used to inflate the cuff, but that postoperative sore throat and dysphagia are more likely at high initial cuff volumes.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of the intubating laryngeal mask tracheal tube with a standard tracheal tube for fibreoptic intubation.
We conducted a prospective randomised study to compare the intubating laryngeal mask tracheal tube with a standard tube, for ease of tracheal intubation over a fibrescope. Thirty-six patients were investigated, using a sequential analysis technique. Ease of intubation was improved when the intubating laryngeal mask tracheal tube was used compared with the standard tube (p = 0.0009). Median (interquartile range [range]) intubation times (time from the tube's tip being level with the patient's teeth to successful placement) were 1.5 (1-2.3 [1-3]) s when the intubating laryngeal mask tracheal tube was used and 5 (3-7.3 [3-13]) s when the standard tube was used (p < 0.0001).