Anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
The immunomodulatory effects of prolonged intravenous infusion of propofol versus midazolam in critically ill surgical patients.
Both propofol and midazolam are known to inhibit immune function. The aim of this study was to investigate cytokine production in critically ill surgical patients as early markers of immune response to prolonged infusion of propofol and midazolam. The study enrolled 40 elective patients who were to receive long-term sedation for more than 2 days. ⋯ In conclusion, during 48 h of continuous infusion, propofol stimulated, while midazolam suppressed, the production of the pro-inflammatory cytokines IL-1beta, IL-6 and TNF-alpha, and both caused suppression of IL-8 production. Propofol inhibited IL-2 production and stimulated IFN-gamma production, whereas midazolam failed to do so. Therefore, sedative agents may have clinical implications in high-risk and immunocompromised patients.
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Randomized Controlled Trial Clinical Trial
High-dose intrathecal diamorphine for analgesia after Caesarean section.
Forty women undergoing elective Caesarean section under spinal anaesthesia using hyperbaric 0.5% bupivacaine were randomly allocated to receive either 0.5 mg or 1 mg intrathecal diamorphine. All women received diclofenac 100 mg at the end of surgery and morphine via a patient-controlled analgesia system. Oral analgesics were not used. ⋯ There were no serious side-effects. Minor side-effects were common but well tolerated, and the incidence did not differ between the groups. If intrathecal diamorphine is used in combination with rectal diclofenac and without oral analgesia, then 1 mg provides superior analgesia to 0.5 mg without any worsening of the side-effects.
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Randomized Controlled Trial Comparative Study Clinical Trial
Randomised double-blind comparison of ondansetron and droperidol to prevent postoperative nausea and vomiting associated with patient-controlled analgesia.
In a randomised, double-blind trial, we compared the use of ondansetron and droperidol for the prevention of nausea and vomiting after total abdominal hysterectomy, during patient-controlled analgesia with morphine. One hundred and forty-two patients were randomly allocated to one of two groups. All patients received a standardised general anaesthetic and postoperative analgesic regimen. ⋯ During the first 24 h after surgery, prophylaxis was successful in 26 of 66 patients given ondansetron (39%) compared with 36 of 71 patients given droperidol (51%). This difference was not statistically significant (Chi-squared = 1.766, p = 0.18). We conclude that in the regimens studied, ondansetron is not more effective than droperidol at preventing postoperative nausea and vomiting.
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Randomized Controlled Trial Clinical Trial
Patient-controlled analgesia and intra-operative suggestion.
In a double-blind randomised study, we investigated the influence of positive intra-operative suggestions, presented to anaesthetised patients undergoing total abdominal hysterectomy, on postoperative pain, nausea and vomiting. One hundred and forty patients were randomly allocated to listen to one of four tapes containing either white noise or positive suggestions. The positive suggestions related to pain, postoperative nausea and vomiting, or both. We found that the positive intra-operative suggestions had no beneficial effects in reducing postoperative pain or nausea scores, nor was the consumption of morphine or anti-emetics reduced.
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Randomized Controlled Trial Comparative Study Clinical Trial
Effect of smoking on induction of anaesthesia with sevoflurane.
Inhalational induction with sevoflurane has been shown to be a viable alternative to intravenous induction; however, studies have focused mainly on healthy patients or volunteers. Airway complications in patients with potential airway irritability have not been studied. Sixty smokers undergoing general anaesthesia were randomly assigned to one of three groups: group 1, vital capacity breathing with 8% sevoflurane; group 2, tidal breathing with 8% sevoflurane; and group 3, tidal breathing with step-up of sevoflurane (sevoflurane concentration increased by increments of 2% every 10 s until 8%). ⋯ Patient satisfaction with the techniques was high with 59 of 60 patients willing to have the same technique again. Inhalational induction with sevoflurane can be used safely as an induction technique in smokers. In common with other patient groups, use of a high initial concentration reduces induction time without causing additional airway or cardiovascular complications.