Anaesthesia
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We have studied the effects of nitrous oxide on the auditory evoked response index (AAI-index) derived from the A-line monitoring device during sevoflurane anaesthesia in 21 patients undergoing minor ambulatory surgery. During sevoflurane anaesthesia with an AAI-index < 30, the addition or withdrawal of nitrous oxide in a concentration of 66% end tidal did not show any linear dose dependent change in AAI-index. However, comparing nitrous oxide > 40% to nitrous oxide < 10% end tidal concentration the AAI-index did decrease, p < 0.05. The AAI-index is either non-linear at deeper anaesthetic levels or is insensitive to the anaesthetic effects of nitrous oxide in terms of MAC-multiples.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of oral transmucosal fentanyl and oral midazolam for premedication in children.
Oral transmucosal fentanyl citrate (OTF) was compared with midazolam as a premedicant in a prospective, randomised, placebo-controlled, double-blind trial. Eighty children (ASA grade 1 or 2, aged 3-9 years) who presented for tonsillectomy were randomly allocated to receive either 2.5 ml OTF (15-20 microg.kg(-1)) in a lollipop format and 0.5 ml.kg(-1) placebo syrup, or midazolam syrup (0.5 mg.kg(-1)) and a placebo lollipop (2.5 ml). The acceptability of sedation, anxiety and compliance with anaesthetic induction were assessed. ⋯ Analgesia requirements, the incidence of vomiting, itching and any behavioural changes were assessed for 6 h postoperatively. Oral transmucosal fentanyl citrate was as effective as midazolam in aiding compliance with anaesthesia, but is significantly better in its appeal to children (p < 0.001) and emergence (p < 0.001) characteristics. In conclusion, OTF may be particularly useful as a premedicant in paediatric practice.
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Randomized Controlled Trial Clinical Trial
Effect of pre-operative anxiolysis on postoperative pain response in patients undergoing total abdominal hysterectomy.
In a double blind, placebo-controlled trial, we have assessed the effects of pre-operative anxiolysis on postoperative pain scores in 112 ASA I-II women, aged 18-65 years, scheduled to undergo total abdominal hysterectomy. Subjects were randomly allocated to receive either oral diazepam 10 mg (n=56) or placebo (n=56) pre-operatively. ⋯ Trait and state anxiety showed a significant effect on pain scores, independent of the treatment group. No difference was found between the groups in morphine consumption, but there was a significant reduction in morphine consumption with time.
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Randomized Controlled Trial Clinical Trial
The effect of a pre-operative infusion of Ringer's solution on splanchnic perfusion in patients undergoing coronary artery bypass grafting.
Surgical patients develop a fluid deficit during pre-operative starvation. This study examines the effects of pre-operative fluid administration on haemodynamic variables, oxygenation and splanchnic perfusion in patients undergoing elective coronary artery bypass grafting. Forty-eight patients were randomised to receive either a pre-operative crystalloid infusion (crystalloid group, n = 24) or no infusion (control group, n = 24). ⋯ Patients in the crystalloid group had a higher splanchnic blood flow than the control group before induction of anaesthesia [mean (SD) = 1782 (573) ml.min(-1) vs. 1391 (333) ml.min(-1), p < 0.05]. There were no significant differences in systemic haemodynamic data and global oxygenation parameters between the two groups. Pre-operative infusion of crystalloid appears to result in an improvement in pre-operative splanchnic perfusion.