British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of i.m. ketorolac trometamol and morphine sulphate for pain relief after cholecystectomy.
I.m. ketorolac trometamol 30 mg was compared with morphine sulphate 10 mg after cholecystectomy in a double-blind, multiple dose, randomized study of 100 patients. Assessments of pain were made immediately after operation (day 1), and the next morning (day 2). Pain intensity (verbal response score and visual analogue scale) was recorded before injection and then over a 6-h period. ⋯ Ketorolac produced significantly less analgesia than morphine on day 1, but on day 2 the two drugs produced a similar effect. Blood loss was not increased by ketorolac, although platelet function was impaired. Repeated i.m. administration of ketorolac did not produce any serious adverse effects.
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Randomized Controlled Trial Comparative Study Clinical Trial
Effects of alfentanil and fentanyl on induction of anaesthesia in patients with severe pregnancy-induced hypertension.
Forty patients with severe pregnancy-induced hypertension presenting for Caesarean section under general anaesthesia were allocated randomly to receive either fentanyl 2.5 micrograms kg-1 or alfentanil 10 micrograms kg-1 as part of the anaesthetic induction sequence. In all patients, the cardiovascular response to tracheal intubation was measured. Both drugs attenuated the response equally but did not abolish it in all patients. Alfentanil 10 micrograms kg-1 is a suitable alternative to fentanyl 2.5 micrograms kg-1 for patients with pregnancy-induced hypertension.
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We have measured whole blood concentrations and pharmacokinetics of propofol administered as a constant rate infusion during cardiac surgery. Ten patients undergoing elective cardiac surgery involving cardiopulmonary bypass (seven myocardial revascularization and three aortic valve surgery) received a continuous infusion of propofol 4 mg kg-1 h-1 to supplement alfentanil analgesia. ⋯ A concentration greater than 1 microgram ml-1 was achieved within 15 min of starting the infusion and remained constant throughout surgery. Volume of distribution, clearance and terminal half-life were similar to those found in non-cardiac patients.
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Randomized Controlled Trial Comparative Study Clinical Trial
Use of post-tetanic count in assessment of a repetitive vecuronium-induced neuromuscular block.
In order to evaluate the use of the post-tetanic count (PTC) method during repetitive administration of vecuronium, we studied 20 patients allocated randomly to one of two groups: 10 patients received droperidol-fentanyl anaesthesia (control group); 10 other patients were given droperidol-fentanyl anaesthesia modified subsequently by addition of 0.5% isoflurane (isoflurane group). Before tracheal intubation, a bolus dose of vecuronium 0.08 mg kg-1 was given i.v. followed by repeated doses of 0.03 mg kg-1. The twitch response of adductor pollicis was recorded after supramaximal stimulation of the ulnar nerve at the wrist using a Myograph 2000 neuromuscular transmission analyser. ⋯ In the isoflurane group, the relationship between PTC and time to first reaction to TOF stimulation remained unchanged after addition of isoflurane. However, isoflurane caused a significant prolongation of the duration of intense block and a corresponding lower PTC in all patients. We conclude that PTC is a reliable method to evaluate intense neuromuscular block caused by vecuronium, even after repetitive administration of the drug and in combination with 0.5% isoflurane.