British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Diamorphine-bupivacaine mixture compared with plain bupivacaine for analgesia.
We have studied the efficacy of two extradural infusions (10 ml h-1) in 50 patients in active labour. Patients in the diamorphine group (n = 25) received 0.0625% plain bupivacaine 6.25 mg h-1 mixed with 0.005% diamorphine 0.5 mg h-1 and those in the control group (n = 25) received 0.125% plain bupivacaine 12.5 mg h-1. ⋯ There were no differences in the incidence of hypotension, instrumental vaginal delivery, number of "top-ups", duration of the second stage or extent of motor block. However, patients in the diamorphine group had a high incidence of pruritus (44%, compared with 0% in the control group (P < 0.01)).
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Randomized Controlled Trial Clinical Trial
Nitrous oxide does not influence operating conditions or postoperative course in colonic surgery.
We studied 150 patients undergoing elective colonic surgery; they were allocated randomly to undergo artificial ventilation with either air-oxygen or nitrous oxide-oxygen during surgery. Eleven patients were excluded. Preoperative management, surgery and postoperative analgesia were similar in both groups. ⋯ The air-oxygen group required a continuous infusion of propofol of 4-6 mg kg-1 h-1 whereas the nitrous oxide-oxygen group required only 1-2 mg kg-1 h-1. There were no differences between the groups in duration of anaesthesia, distension of the bowel and postoperative bowel function. The postoperative hospital stay was similar for both groups.
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Randomized Controlled Trial Clinical Trial
Optimum dose of neostigmine at two levels of atracurium-induced neuromuscular block.
There is controversy about the optimum dose of neostigmine for antagonizing neuromuscular block. We have studied 57 patients undergoing gynaecological surgery to establish a dose-response relationship when neostigmine was given to antagonize atracurium-induced block. Anaesthesia was induced with thiopentone and fentanyl and maintained with nitrous oxide and enflurane in oxygen and neuromuscular block was produced with a bolus of atracurium 0.5 mg kg-1. ⋯ There was little benefit in increasing the dose of neostigmine from 40 micrograms kg-1 to 80 micrograms kg-1 when antagonizing profound neuromuscular block. When light block was antagonized, neostigmine 20 micrograms kg-1 was the optimum dose. We suggest that smaller doses of neostigmine than are given commonly produce adequate antagonism of atracurium-induced neuromuscular block.
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Although mixed venous oxygen saturation (SVO2) is related to the reciprocal of cardiac output (CO) if both arterial oxygen content and oxygen consumption remain constant, simultaneous alterations in the three variables may occur immediately after discontinuation of cardiopulmonary bypass (CPB). To examine if continuous monitoring of SVO2 using a fibreoptic pulmonary artery catheter would be useful for detecting alterations in CO immediately after discontinuation of CPB, we have examined the relationships between changes in SVO2, cardiac index (CI), oxygen consumption and haemoglobin concentration in 15 cardiac surgical patients. ⋯ However, changes in SVO2 did not correlate with either oxygen consumption or haemoglobin concentration. The current results suggest that continuous monitoring of SVO2 with the fibreoptic pulmonary artery catheter may be useful for detecting changes in CO after discontinuation of CPB in patients with compromised cardiac function.
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We have defined the infusion dose requirements of propofol to suppress consciousness and response to a variety of graded non-noxious and noxious stimuli in 52 unpremedicated patients aged 16-40 yr and 32 patients aged 41-65 yr. They were allocated to receive one of five loading dose-infusion schemes designed to establish stable conditions covering the range from wakefulness, through sedation, to loss of consciousness and anaesthesia. ⋯ In both groups the dose-response curves for suppression of proprioception, finger counting and perception of light touch in conscious patients were shifted to the left of the curves for loss of consciousness and eyelash reflex. Dose-response curves for noxious stimuli were shifted to the right of those for loss of consciousness.