British journal of anaesthesia
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Multicenter Study Clinical Trial
Rocuronium (Org 9426) for caesarean section.
This was a prospective, non-randomized, multicentre study of rocuronium (Org 9426) in 40 elective Caesarean section patients at full term without fetal distress. Anaesthesia was induced with thiopentone 4-6 mg kg-1 i.v. and rocuronium 0.6 mg kg-1 and maintained with isoflurane and nitrous oxide in oxygen. Monitors included ECG, arterial pressure, pulse oximeter and train-of-four (TOF) produced by ulnar nerve stimulation. ⋯ Rocuronium had no clinically significant effect on maternal heart rate or arterial pressure. After administration of thiopentone and rocuronium in two patients, temporary erythema occurred, one along the site of injection and the other on the chest wall. Rocuronium had no untoward effects on the neonates, evaluated by 1- and 5-min Apgar scores, time to sustained respiration, total and muscular neuroadaptive capacity scores, acid-base status and blood-gas tensions in umbilical arterial and venous blood.(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Clinical Trial
Ondansetron does not inhibit the analgesic effect of alfentanil.
5-Hydroxytryptamine (5-HT) causes antinociception via presynaptic 5-HT3 (5-HT subtype 3) receptors on primary afferent nociceptive neurones in the spinal cord dorsal horn. Therefore, ondansetron (a 5-HT3 receptor antagonist) may increase the perception of a noxious stimulus or decrease the effects of concurrently administered antinociceptive drugs. Using a randomized, double-blind, crossover study design, we have tested this hypothesis in eight healthy volunteers who, on three different days, received either ondansetron and placebo, ondansetron and alfentanil or placebo and alfentanil. ⋯ Ondansetron alone did not change the response to any of the experimental tests, but alfentanil and the combination ondansetron-alfentanil significantly changed the response compared with ondansetron alone. There was no difference between alfentanil alone and the combination ondansetron-alfentanil. We conclude that ondansetron does not change the response to pressure, heat, cold or electrical nociceptive stimuli or antagonize the analgesic effect of alfentanil.
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We describe an anaesthesia simulator capable of simulating all possible situations during anaesthesia. The Leiden anaesthesia simulator (LAS) may be used with most commercially available anaesthesia equipment and monitors, which are connected to the simulated patient as they are to a patient. A commercially available intubation manikin attached to an electromechanical lung model represents the patient. ⋯ The task of the trainee is to diagnose and treat the problem as if in real life. The simulator experiences on the LAS were judged as highly realistic by 28 subjects. This simulator is currently being used for teaching and training of anaesthetists, trainees and anaesthesia personnel and for research.
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Clinical Trial Controlled Clinical Trial
Effect of fentanyl on awakening concentration of sevoflurane.
This study was designed to determine if fentanyl altered MAC-awake (the end-tidal concentration of sevoflurane associated with eye opening to verbal command) in 30 healthy, ASA I patients. During anaesthesia, no other anaesthetics or drugs were given with the exception of sevoflurane. After surgery, end-tidal anaesthetic concentration was maintained constant for at least 15 min. ⋯ In the fentanyl 1-ng ml-1 group, MAC-awake (0.65 (0.10)% or 0.34 (0.05) MAC) did not differ from that in the control group. Logistic regression analysis showed that increasing plasma concentration of fentanyl and increasing age significantly reduced the MAC-awake of sevoflurane. Because the reduction was very small relative to the overall scatter of the MAC-awake, a low plasma concentration of fentanyl did not significantly reduce the MAC-awake of sevoflurane.