British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
New patch delivery system for percutaneous local anaesthesia.
We have assessed the release of amethocaine from a new patch delivery system and subsequent drug diffusion through human stratum corneum and whole skin. We found that the patch system was more efficient than an amethocaine gel preparation. ⋯ Furthermore, a 30-min application of the patch was sufficient to provide profound and prolonged topical anaesthesia in all volunteers. In contrast, although a 60-min application of EMLA was necessary to ensure satisfactory onset of percutaneous anaesthesia, the duration of action was much shorter than that of the amethocaine patch.
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Randomized Controlled Trial Comparative Study Clinical Trial
Presurgical analgesia in children subjected to hypospadias repair.
We have examined the use of different pre-surgical analgesic techniques in 30 children aged 2-10 yr undergoing repair of hypospadias. They were allocated randomly, in a double-blind, placebo-controlled study, to receive one of three analgesic techniques (n = 10): lumbar extradural analgesia using 0.5% bupivacaine 1 mg kg-1 plus morphine 50 micrograms kg-1; morphine 100 micrograms kg-1 i.m.; or subpubic block using 0.5% bupivacaine 0.5 mg kg-1 for each side. ⋯ Children given extradural analgesia had more stable haemodynamic variables and smaller catecholamine concentrations and needed less anaesthetic supplementation, with no analgesic requirement in the postoperative period. Nausea or vomiting were not reported in children given subpubic block.
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Randomized Controlled Trial Clinical Trial
Synergism between atracurium and vecuronium in children.
In 30 children under balanced anaesthesia, we have determined dose-response curves and maintenance requirement of three dose ratio combinations of atracurium and vecuronium (10:1, 4:1 or 1.6:1 on a microgram:microgram basis). Neuromuscular block was monitored by adductor pollicis EMG. An equipotent dose ratio (4:1) was most potent, with a mean (SEM) ED95 of atracurium 95 (6) micrograms kg-1 with vecuronium 24 (1) micrograms kg-1. ⋯ These results indicate that a combination of atracurium and vecuronium is supra-additive compared with the effects of each drug alone. However, all combinations maintained an intermediate character of neuromuscular block. Combining atracurium with vecuronium may reduce drug requirement by 40%.
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Randomized Controlled Trial Clinical Trial
Perioperative monitoring with pulse oximetry and late postoperative cognitive dysfunction.
In a randomized, blinded clinical study, we have used objective and subjective measures to determine if perioperative monitoring with pulse oximetry--by virtue of its potential to lessen hypoxaemia--would decrease late postoperative cognitive dysfunction. We investigated 736 adult patients undergoing elective procedures (other than cardiac, neurosurgical or for cancer) under regional or general anaesthesia, allocated randomly to undergo (group I) or not to undergo (group II) pulse oximetry monitoring in the operating theatre and recovery room. Cognitive function was evaluated using the Wechsler memory scale (WMS) and continuous reaction time (RT) test the day before surgery, and on the 7th day after operation or at discharge if that occurred before postoperative day 7. ⋯ For the 40 patients whose WMS scores were 10 points less after than before operation, a follow-up study was undertaken 3 months after surgery. At that time, the median WMS score had returned to the preoperative value. We conclude that, for these 736 patients, subjective and objective measures did not indicate less postoperative cognitive impairment after perioperative monitoring with pulse oximetry.
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Randomized Controlled Trial Clinical Trial
Patient-controlled analgesia with a mixture of morphine and droperidol.
In a prospective study, 50 women who had undergone uncomplicated abdominal hysterectomy under general anaesthesia were allocated randomly to receive patient-controlled analgesia with either morphine alone or a mixture of morphine and droperidol. Bolus doses of morphine 1 mg and droperidol 0.05 mg were used with a lockout time of 5 min. During the first 24 h after surgery the mean (range) dose of droperidol in the droperidol group was 3.2 (1.9-6.0) mg. ⋯ In the morphine alone group, 19 patients required additional antiemetic therapy, whereas in the droperidol group only one patient found this necessary (P < 0.001). Extrapyramidal side effects were not observed in any patient. Significantly more patients were of the opinion that PCA had provided excellent analgesia when droperidol had been used (P < 0.01).