British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Sedation for fibreoptic gastroscopy: a comparative study of midazolam and diazepam.
Midazolam, a water-soluble benzodiazepine, was compared with diazepam in fat emulsion (Diazemuls) as sedation for outpatient gastroscopy in a randomized double-blind fashion. Midazolam 0.05 mg kg-1 was found to be approximately equipotent to Diazemuls 0.15 mg kg-1. There were no differences concerning speed of recovery and all patients were considered ready for discharge after 2 h. ⋯ With the same degree of sedation, midazolam produced a higher frequency of amnesia (60% v. 7%; P less than 0.001) for the endoscopic procedure. Although the patients appeared to prefer midazolam to Diazemuls, this difference was significant only in patients who had not previously undergone gastroscopy (P less than 0.05). The high degree of amnesia with midazolam may be an advantage in sedation for unpleasant procedures like gastroscopy.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of effects of intraoperative and postoperative methadone: acute tolerance to the postoperative dose?
The effects of methadone 10 mg administered in two different clinical contexts, at induction of anaesthesia and following operation, were studied in two groups of patients undergoing elective total hip replacement. The intraoperative group received methadone 10 mg i.v. at induction of anaesthesia as part of a balanced anaesthetic technique. The postoperative group received methadone 10 mg i.v. following operation, extradural bupivacaine being used for the operative period. ⋯ Subsequently, the postoperative group had a significantly greater analgesic requirement which resulted in significantly greater plasma methadone concentrations the following morning. Thus, the administration of methadone following operation appeared to exert less analgesic effect than the same dose given during operation. The reasons for this are discussed.
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Randomized Controlled Trial Comparative Study Clinical Trial
Psychomimetic reactions after low-dose ketamine infusion. Comparison with neuroleptanaesthesia.
Low-dose ketamine anaesthesia was compared with neuroleptanaesthesia, in respect of immediate and longer-term psychomimetic reactions, in 40 female patients undergoing elective gynaecological surgery. Qualitatively, but not quantitatively, different psychomimetic reactions occurred in both groups. ⋯ Interviews after 3 months revealed a low frequency of psychomimetic reactions in both groups. However, 30% of all the patients (12) complained of impairment of intellectual function, and in seven patients this was severe enough to interfere with their ability to work.