Anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Nefopam or clonidine in the pharmacologic prevention of shivering in patients undergoing conscious sedation for interventional neuroradiology.
The aim of this randomised, double-blind study was to investigate the usefulness of intravenous nefopam, clonidine or placebo in preventing shivering in patients undergoing conscious sedation for interventional neuroradiological procedures. A total of 101 patients were prospectively enrolled and assigned to one of three groups to receive nefopam, clonidine or placebo. ⋯ We found that both nefopam and clonidine significantly lowered the rate and severity of shivering during interventional neuroradiological procedures. Fewer patients in the nefopam group than in the other two groups required vasoactive drugs.
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Randomized Controlled Trial Clinical Trial
Impact on postoperative pain of long-lasting pre-emptive epidural analgesia before total hip replacement: a prospective, randomised, double-blind study.
Clinical studies on pre-emptive analgesia have produced inconsistent results. We conducted a clinical study investigating the effect of long-lasting pre-emptive epidural analgesia on consumption of analgesics and acute pain. Forty-two patients scheduled for elective hip replacement for osteo-arthritis were randomly assigned to receive, on the day before operation, either 5 ml.h(-1) ropivacaine 0.2% (study group, n = 21) or 5 ml.h(-1) saline (control group, n = 21). ⋯ Furthermore, bolus requests occurred more frequently in the control group. VAS scores did not differ significantly between groups. Long-lasting "pre-emptive" epidural analgesia decreases postoperative pain with improved pain control.
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Randomized Controlled Trial Comparative Study Clinical Trial
Clinical comparison of three different anaesthetic depth monitors during cardiopulmonary bypass.
The lack of a gold standard complicates the evaluation and comparison of anaesthetic depth monitors. This randomised study compares three different depth-of-anaesthesia monitors during cardiopulmonary bypass (CPB) at 34 degrees C with fentanyl/propofol anaesthesia adjusted clinically and blinded to the monitors. Coronary artery bypass grafting patients (n = 21) were randomly assigned to all three possible paired combinations of three monitors: Bispectral Index (Aspect Medical), AAI auditory evoked potential (Danmeter), Entropy (Datex-Ohmeda). ⋯ Anaesthesia was classed as adequate, inadequate, or excessive according to recommended index values. Of the 255 paired indices recorded, 62% showed good agreement, 33% showed non-agreement, and 5% showed disagreement. Using good agreement between two monitors as a gold standard, a quarter of the measurements indicate inappropriate anaesthetic depth monitoring during CPB with clinically titrated anaesthetic depth.
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Randomized Controlled Trial Comparative Study Clinical Trial
Evaluation of ease of intubation with the GlideScope or Macintosh laryngoscope by anaesthetists in simulated easy and difficult laryngoscopy.
The GlideScope is a new video laryngoscope developed for management of the difficult airway. We compared the GlideScope with the Macintosh laryngoscope in simulated easy and difficult laryngoscopy. Twenty anaesthetists were allowed three attempts to intubate in each of four laryngoscopy scenarios in a high fidelity simulator. ⋯ In the simulated difficult laryngoscopy scenarios, the anaesthetists took less time to intubate using the GlideScope (23.5 (12.7) s vs. 70.5 (101.2) s, respectively; p = 0.001). The slightly higher success rate with the GlideScope was not statistically significant (20/20 vs. 18/20, respectively; p = 0.5). However, the anaesthetists found it easier to intubate using the GlideScope (median (interquartile range [range]) 1 (1-2 [1-2]) vs. 2 (2-3 [1-3]), respectively; p < 0.0001).
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The role of vascular tone in determining cerebral perfusion pressure is increasingly being appreciated. It has been suggested that zero flow pressure, the arterial pressure at which blood flow ceases, represents the effective downstream pressure of the cerebral circulation. Nitrous oxide is a cerebral vasodilator and may therefore decrease zero flow pressure and increase cerebral perfusion pressure. ⋯ We studied eight healthy volunteers at normocapnia and studied the effects of the inhalation of nitrous oxide 50% on estimated cerebral perfusion pressure and zero flow pressure using transcranial Doppler ultrasonography. We found that nitrous oxide 50% significantly increased estimated cerebral perfusion pressure (p = 0.03), whilst decreasing zero flow pressure (p = 0.01). These results suggest that the vasomotor effects of nitrous oxide predominate in determining the effective downstream pressure of the cerebral circulation in healthy individuals.