British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Peroperative nitrous oxide delays bowel function after colonic surgery.
Forty patients scheduled for elective colonic surgery were allocated at random to receive either nitrous oxide or air during surgery. Preoperative management, surgery, parenteral therapy and postoperative analgesics were similar in both groups. Anaesthetic management included isoflurane, vecuronium by infusion and fentanyl 3 micrograms kg-1 h-1. ⋯ No differences were found in duration of operation, blood loss, need for postoperative analgesia or postoperative nausea. Patients in the air group had less gas in the small bowel (P less than 0.005) and in the large bowel (P less than 0.001), and operating conditions were better than in the nitrous oxide group (P less than 0.01). After operation, the air group had significantly earlier bowel function than the nitrous oxide group, with earlier passing of flatus (3.4 (1.2) vs 4.7 (1.4) days) (P less than 0.05) and faeces (4.7 (1.5) vs 6.3 (2.2) days) (P less than 0.05) and required a shorter postoperative hospital stay (10.0 (1.3) vs 11.7 (2.5) days) (P less than 0.05).
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Randomized Controlled Trial Clinical Trial
Depth and duration of skin analgesia to needle insertion after topical application of EMLA cream.
We have determined the depth and duration of analgesia to needle insertion after topical application of EMLA cream (Eutectic Mixture of Local Analgesics). EMLA was applied for 30, 60, 90 and 120 min and the sensory and pain threshold depths were determined before analgesia (1.0 and 1.9 mm, respectively) and up to 4 h after the cream was removed from the skin. ⋯ For application times shorter than 120 min, the depth of analgesia increased during the period after removal of the cream. This suggests new guidelines for the use of this topical analgesic.
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A case is described of profound respiratory depression occurring 100 min after the extradural administration of fentanyl 100 micrograms to a patient undergoing Caesarean section.
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Clinical Trial Controlled Clinical Trial
Neuromuscular block with doxacurium (BW A938U) in patients with normal or absent renal function.
The characteristics of neuromuscular block induced by doxacurium were compared in patients with and without renal function. Seventeen patients with end stage chronic renal failure and 18 patients with normal renal function were anaesthetized with 0.5% halothane and nitrous oxide in oxygen and received doxacurium in an initial dose of 25 micrograms kg-1 (estimated from available data as an ED95 dose), with incremental doses of 5 micrograms kg-1. At the end of surgery, residual neuromuscular block was antagonized with either edrophonium 1.0 mg kg-1 or neostigmine 0.08 mg kg-1. ⋯ The rate of spontaneous recovery from doxacurium as indicated by the time for twitch height to recover from 0 to 5%, 5 to 10% and 10 to 25%, was not significantly different in the two groups. Antagonism of doxacurium was achieved more reliably with neostigmine than with edrophonium in both groups. The administration of doxacurium was associated with minimal cardiovascular effects.
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A 14-yr-old boy with fibrodysplasia ossificans progressiva (FOP) presented for surgery for bilateral division of his ossified masseter muscles. Patients with FOP may present problems to the anaesthetist, including difficulties with tracheal intubation, restrictive pulmonary disease and abnormalities of cardiac conduction. With our patient sedated the trachea was intubated using a fibrescope and anaesthesia was induced and maintained with nitrous oxide and enflurane in oxygen. Ventilation was controlled throughout surgery and recovery was uneventful.