British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Dose-response relationships for edrophonium and neostigmine antagonism of mivacurium-induced neuromuscular block.
We have studied the dose-response relationships for neostigmine and edrophonium during antagonism of neuromuscular block induced by mivacurium chloride. Sixty-four ASA group I or II adults were given mivacurium 0.15 mg kg-1 during fentanyl-thiopentone-nitrous oxide-isoflurane anaesthesia. Train-of-four stimulation (TOF) was applied to the ulnar nerve every 10 s, and the force of contraction of the adductor pollicis muscle was recorded. ⋯ The doses of neostigmine required to achieve 50% (ED50) and 70% (ED70) recovery of the first twitch after 10 min were 2 (1.5-2.5) micrograms kg-1 and 4.7 (4.1-5.4) micrograms kg-1 (mean (95% confidence intervals)), respectively. Corresponding ED50 and ED70 values for edrophonium were 2.8 (0.75-10.2) micrograms kg-1 and 9.2 (3.6-23.6) micrograms kg-1, respectively. These values corresponded to neostigmine:edrophonium potency ratios of 1.4 (0.4-2.4) and 1.95 (0.9-2.9) for first twitch ED50 and ED70 height, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of patient-controlled analgesia with and without a background infusion after lower abdominal surgery in children.
Forty children aged 6-12 yr undergoing appendicectomy were allocated randomly to receive postoperative i.v. morphine by a patient-controlled analgesia (PCA) system (bolus dose 20 micrograms kg-1 with a lockout interval of 5 min) or the same PCA with a background infusion of morphine 20 micrograms kg-1 h-1. Patients breathed air and oxygen saturation was monitored by continuous pulse oximetry. Scores for pain, sedation and nausea were recorded hourly. ⋯ There were no significant differences in the pain scores of the two groups. Patients with PCA+background infusion suffered more nausea (P < 0.01), more sedation (P < 0.05) and hypoxaemia (P < 0.001) than those with PCA only. They also had a better sleep pattern than those with PCA only.
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Randomized Controlled Trial Clinical Trial
Tropisetron for postoperative nausea and vomiting in patients after gynaecological surgery.
In a double-blind study, we have compared the prophylactic antiemetic effect of tropisetron 5 mg (Navoban, a 5-HT3 receptor antagonist) with that of placebo, both given as a short i.v. infusion approximately 15 min before wound closure in patients undergoing gynaecological surgery. Perioperative anaesthetic care was standardized and patients were observed for at least 24 h after operation. ⋯ Vomiting occurred in 26% of tropisetron-treated patients, compared with 59% of placebo-treated patients (P = 0.006); 69% of tropisetron-treated patients suffered nausea, compared with 88% of placebo-treated patients (P = 0.05). In addition, patients judged the antiemetic treatment with tropisetron as more effective than the placebo treatment (visual analogue score 71 vs 51 mm (P = 0.003)).
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Randomized Controlled Trial Clinical Trial
Clonidine combined with sufentanil and bupivacaine with adrenaline for obstetric analgesia.
Clonidine produces analgesia via a non-opioid mechanism and it may be used as an interesting adjuvant to local anaesthetics and opioids in obstetric analgesia. To examine the effects of the addition of clonidine to bolus injections of bupivacaine, adrenaline and sufentanil, we enrolled 50 women receiving extradural analgesia for vaginal delivery into a double-blind study. They were allocated randomly to two groups: group A received a 10-ml extradural solution of bupivacaine 12.5 mg combined with adrenaline 25 micrograms and sufentanil 10 micrograms; group B received the same solution with clonidine 30 micrograms. ⋯ During the first and second stages of labour, there was no difference between the two groups in duration of analgesia after the first injection (142 min in group A; 127 min in group B), number of injections (1.8 in group A; 1.9 in group B) and the total bupivacaine requirements (33.9 mg in group A; 34 mg in group B). The quality of analgesia was evaluated as very good in both groups (23/25 in group A; 24/25 in group B). The degree of motor block or the frequency of other side effects were not enhanced by clonidine.(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Clinical Trial
Effects of increasing doses of alfentanil, fentanyl and morphine on mid-latency auditory evoked potentials.
We have studied dose-dependent effects of alfentanil, fentanyl and morphine on mid-latency auditory evoked potentials (MLAEP). Anaesthesia was induced with alfentanil 100 micrograms kg-1 every 5 min to a total dose of 500 micrograms kg-1 (group I, n = 10), fentanyl 10 micrograms kg-1 every 7 min to a total dose of 50 micrograms kg-1 (group II, n = 10) or morphine 1 mg kg-1 for induction and 0.5 mg kg-1 every 15 min to a total dose of 3 mg kg-1 (group III, n = 10). MLAEP were recorded before and 3-15 min after every opioid dose on vertex (positive) and mastoids on both sides (negative). ⋯ There was a marked increase only in latency and decrease in amplitude of P1. In contrast, for the early cortical potentials Na and Pa, only small increases in latencies and decreases in amplitudes were observed. After the largest doses of alfentanil (500 micrograms kg-1), fentanyl (50 micrograms kg-1) and morphine (3 mg kg-1), Na, Pa and Nb showed a similar pattern as in awake patients.(ABSTRACT TRUNCATED AT 250 WORDS)