British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of the reinforced laryngeal mask airway and tracheal intubation for adenotonsillectomy.
One-hundred and four patients were allocated randomly to receive anaesthesia for adenotonsillectomy via either a reinforced laryngeal mask airway or tracheal tube. Airway maintenance and protection were assessed during and after operation. ⋯ In children, recovery was less eventful in the laryngeal mask airway group, with less airway obstruction (P < 0.001) and better airway acceptance (P < 0.05). The reinforced laryngeal mask airway provided a clear, secure airway until recovery of protective reflexes.
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Randomized Controlled Trial Clinical Trial
Intra-articular morphine for pain relief after anterior cruciate ligament repair.
We have performed a randomized, double-blind controlled study in patients undergoing elective anterior cruciate ligament repair, to assess the effect of intra-articular morphine on postoperative pain. The morphine group (n = 11) received morphine 5 mg in saline 25 ml and the control group (n = 9), saline 25 ml intra-articularly. Patients in the morphine group had significantly smaller pain scores throughout the 24-h postoperative period compared with those in the control group (P < 0.05). There was less requirement for supplementary analgesics in the morphine group.
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Randomized Controlled Trial Clinical Trial
Nitrous oxide-mediated activation of the EEG during isoflurane anaesthesia in patients.
We have studied the effects of nitrous oxide on EEG burst suppression patterns during stable isoflurane anaesthesia in 13 ASA I patients. After induction of anaesthesia with propofol, the concentration of isoflurane was increased with continuous EEG monitoring to burst suppression level (mean end-tidal concentration of isoflurane, 1.7 (SD 0.2)%), and kept constant during the study. During surgery, isoflurane in air and oxygen (FIO2 0.35), or isoflurane in 65% nitrous oxide in oxygen were given to each patient for 30 min, in random order. ⋯ The proportion of EEG suppression time was measured after a washin or washout period of at least 15 min for nitrous oxide. There was a significant decrease in the proportion of EEG suppression time (from 69.5 to 43.7%) when air was replaced by nitrous oxide. We conclude that the EEG effects of isoflurane and nitrous oxide are not additive and that nitrous oxide opposes the depression of isoflurane on the central nervous system.
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Thirty-two women underwent major gynaecological surgery with a midazolam-alfentanil total i.v. anaesthetic regimen. Adequacy of anaesthesia was assessed using a "pressure, rate, sweating and tears" (PRST) scoring system in conjunction with the isolated forearm technique (IFT). The IFT revealed that 72% of patients responded during surgery, but none had spontaneous, unprompted postoperative recall for the event. ⋯ Twenty patients, asked specifically during surgery to indicate the presence or absence of pain, experienced pain at some time during their surgical procedure. The PRST score could not be used to predict when a patient was awake. This low-dose i.v. anaesthetic technique cannot be recommended for general use.
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Randomized Controlled Trial Clinical Trial
Use of alfentanil with propofol for nasotracheal intubation without neuromuscular block.
We have investigated the effect of augmentation of propofol with alfentanil for nasotracheal intubation without neuromuscular block in 60 patients undergoing short elective maxillo-facial procedures as outpatients. After administration of glycopyrronium 5 micrograms kg-1 i.v., anaesthesia was induced with propofol 2.5 mg kg-1, or alfentanil 20 micrograms kg-1 and propofol 2.5 mg kg-1. ⋯ This difference was not significant. The cardiovascular response to intubation was attenuated in the alfentanil group.