Anaesthesia
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Randomized Controlled Trial
Subcutaneous naloxone for the prevention of intrathecal morphine induced pruritus in elective Caesarean delivery.
The aim of this study was to assess the antipruritic efficacy of subcutaneous naloxone following intrathecal morphine administration. Fifty women undergoing elective Caesarean section using spinal anaesthesia were randomly allocated, in a double-blind study design, to receive either naloxone 400 microg or placebo as a subcutaneous injection at the end of surgery. Spinal anaesthesia was performed using 0.5% hyperbaric bupivacaine, 25 microg fentanyl and 150 microg of preservative-free morphine sulphate. ⋯ The incidence of pruritus and nausea and vomiting was not significantly different between the two groups. There was also no significant difference in postoperative analgesia between the two groups. We conclude that pruritus, following intrathecal fentanyl 25 microg and preservative-free morphine sulphate 150 microg, is not reduced by the addition of naloxone 400 microg administered subcutaneously on the completion of surgery.
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Randomized Controlled Trial Comparative Study
A comparison of the clinical use of the Laryngeal Tube S and the ProSeal Laryngeal Mask Airway by first-month anaesthesia residents in anaesthetised patients.
The Laryngeal Tube S and the LMA-ProSeal are supraglottic instruments with an improved airway seal and a drainage tube to protect against regurgitation and to facilitate passage of a gastric tube. We compared the feasibility of these two instruments in a randomised, controlled clinical trial. One hundred and sixty patients were randomly allocated to undergo insertion of a Laryngeal Tube S (n = 82) or an LMA-ProSeal (n = 78). ⋯ Gastric tube placement was successful in all patients in the Laryngeal Tube S group, but failed in 12 patients in the LMA-ProSeal group (p < 0.001). Dysphagia was reported by 22% of Laryngeal Tube S group and 3% of LMA-ProSeal group (p = 0.001). These findings demonstrate the applicability of the devices and a learning effect in the hands of anaesthesia residents with limited experience.
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Randomized Controlled Trial Comparative Study
A comparison of the disposable Ambu AuraOnce Laryngeal Mask with the reusable LMA Classic laryngeal mask airway.
Single-use supraglottic airway devices are now available and are intended to be comparable with the reusable LMA Classic laryngeal mask airway. We performed a randomised cross-over study comparing the Ambu AuraOnce Laryngeal Mask with the LMA Classic. Fifty patients participated in the trial. ⋯ Visual analogue scores for ease of insertion were 87 (73-93 [26-97]) mm for the Ambu and 84 (60-89 [18-96]) for the LMA Classic (p = 0.017). Complications were similar in both groups. We suggest that the disposable Ambu Laryngeal Mask is an acceptable alternative to the reusable LMA Classic.
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Randomized Controlled Trial
Fentanyl dose-response curves when inserting the LMA Classic laryngeal mask airway.
Probit analysis was used to predict an optimal dose of fentanyl, co-administered with propofol 2.5 mg.kg(-1), when inserting the laryngeal mask airway. In all, 21 male and 54 female healthy Chinese patients, aged 18-63 years, requiring anaesthesia for minor surgery were recruited. They were assigned to one of five groups: placebo, 0.5, 1.0, 1.5 and 2.0 microg.kg(-1). ⋯ To provide optimal conditions in over 95% of patients, fentanyl doses well above the clinical range were required. A standard fentanyl dose of 1 mug.kg(-1), co-administered with propofol 2.5 mg.kg(-1), provided optimal conditions in 65% of cases. Ninety seconds may have been insufficient time for fentanyl to reach its peak effect.
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Randomized Controlled Trial Comparative Study
Effect site concentration during propofol TCI sedation: a comparison of sedation score with two pharmacokinetic models.
Target controlled infusion (TCI) pumps function using a programme based on a pharmacokinetic/pharmacodynamic model. We compared the Marsh and Schnider models to find out which better correlates with the clinically observed effect of propofol as assessed by the Observer Assessment of Alertness/Sedation (OAAS) score and the Bispectral index. ⋯ We calculated the effect site concentration predicted by both models for all the patients. Changes in the sedation score and Bispectral index correlated better with the Marsh than with the Schnider effect site prediction in both study groups.