Anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Epidural fentanyl in labour. An evaluation of the systemic contribution to analgesia.
In a randomized double-blind trial in the first stage of labour, 20 patients given fentanyl 80 micrograms in the epidural test dose of bupivacaine, were compared with 20 patients receiving an intravenous infusion designed to produce comparable plasma fentanyl concentrations, at the same time as their epidural test dose. Despite slightly higher plasma fentanyl concentrations in the intravenous fentanyl group, epidural fentanyl produced analgesia which was more complete, more rapid in onset and slightly longer lasting. Supplementary doses of bupivacaine were needed to produce analgesia in 75% of the intravenous and 30% of the epidural fentanyl group. It is clear that epidural fentanyl produces satisfactory pain relief when added to the epidural test dose, but that the presence of fentanyl in the systemic circulation makes a negligible contribution to analgesia.
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Comparative Study
The haemodynamic effects of intravenous induction. Comparison of the effects of thiopentone and propofol.
The haemodynamic changes following induction of anaesthesia with equipotent doses of propofol and thiopentone have been compared. Propofol caused a significant fall in arterial blood pressure and total peripheral resistance, with a slight fall in cardiac output. ⋯ Apart from an initial, but statistically insignificant increase in heart rate, similar changes were produced by thiopentone, but to a lesser degree. It is concluded that induction of anaesthesia with propofol results in acceptable haemodynamic changes, but that the agent is more depressant to the cardiovascular system than thiopentone.
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The action of midazolam is influenced by serum protein binding as seen in the relationship between the time of onset of action of a fixed dose of the drug and the plasma albumin. Pretreatment with intravenous aspirin produces a decrease in the in vitro binding of midazolam. ⋯ Probenecid pretreatment will also cause a decrease in the onset time of midazolam. However, this is not due to altered plasma protein binding of the sedative.
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Comparative Study
Volume-controlled high frequency positive pressure ventilation for upper abdominal surgery. A clinical report.
Volume-controlled high-frequency positive pressure ventilation was evaluated and compared to intermittent positive pressure ventilation during anesthesia in 74 patients undergoing biliary tract surgery. There were no statistically significant differences in oxygenation or ventilation. Significantly lower airway pressures and lower tidal volumes were recorded during high frequency positive pressure ventilation. ⋯ Used intra-operatively, it also produced a quiet operative field, which the surgeons appreciated during cannulation of the biliary duct and stapling of the stomach. At the end of the anaesthesia, high frequency positive pressure ventilation was superimposed on spontaneous breathing and operated as a new mode of intermittent mandatory ventilation. This reduced the risk of hypoxia at the time of emergence from anaesthesia and at tracheal suctioning.
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Randomized Controlled Trial Comparative Study Clinical Trial
Suprofen compared to dextropropoxyphene hydrochloride and paracetamol (Cosalgesic) after extraction of wisdom teeth under general anaesthesia.
In a randomised double-blind trial in postoperative ambulant day case dental patients suprofen 200 mg (29 patients) was compared with dextropropoxyphene hydrochloride 65 mg and paracetamol 650 mg (Cosalgesic, 28 patients) both available four times daily for 3 days. Suprofen was better than cosalgesic in the patients' opinion of initial (p = 0.01) and overall pain relief (p = 0.08) compared to Cosalgesic and the second night's sleep was better (p = 0.01). Side effects were reported in six suprofen patients and 10 cosalgesic patients (two suffering from vomiting withdrew). Suprofen, a non-steroidal anti-inflammatory drug is as good as, or better than, a widely used opioid-paracetamol mixture for ambulant patients with postoperative dental pain.