British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial Controlled Clinical Trial
Manual compared with target-controlled infusion of propofol.
We studied 160 ASA I-II patients, anaesthetized with propofol by infusion, using either a manually controlled or target-controlled infusion system. Patients were anaesthetized by eight consultant anaesthetists who had little or no previous experience of the use of propofol by infusion. In addition to propofol, patients received temazepam premedication, a single dose of fentanyl and 67% nitrous oxide in oxygen. ⋯ With the exception of a clinically insignificant difference in heart rate, haemodynamic variables were similar in the two groups. Six of the eight anaesthetists found the target-controlled system easier to use, and seven would use the target-controlled system in preference to a manually controlled infusion. Anaesthetists without prior experience of propofol infusion anaesthesia quickly became familiar with both manual and target-controlled techniques, and expressed a clear preference for the target-controlled system.
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Randomized Controlled Trial Comparative Study Clinical Trial
Extradural, paravertebral and intercostal nerve blocks for post-thoracotomy pain.
Forty-five patients were allocated randomly to receive either a single intrathoracic block of four intercostal nerves, a continuous thoracic extradural infusion or a continuous paravertebral infusion of bupivacaine. Patients were allowed additional i.v. boluses of morphine via a PCA device. ⋯ There were no significant differences between the groups in pain, morphine consumption, respiratory function or adverse events. Moderate to severe respiratory depression was detected in 14 patients more than 2 h after operation.
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Randomized Controlled Trial Comparative Study Clinical Trial
Histamine-release haemodynamic changes produced by rocuronium, vecuronium, mivacurium, atracurium and tubocurarine.
We have examined the effects of different benzyl-isoquinolinium and steroidal neuromuscular blocking compounds on plasma concentrations of histamine, heart rate and arterial pressure in surgical patients. A single, rapid (5-s) bolus of mivacurium 0.2 mg kg-1, atracurium 0.6 mg kg-1, tubocurarine 0.5 mg kg-1, vecuronium 0.1 mg kg-1 or rocuronium 0.6 mg kg-1 was administered to 75 patients (n = 15 in each group). Anaesthesia was induced with thiopentone 6 mg kg-1 i.v. and maintained with isoflurane and 70% nitrous oxide in oxygen. ⋯ Corresponding values at 3 min were 223%, 148% and 157%, respectively. These changes were significant (P < 0.01) at 1 and 3 min. In contrast, the rocuronium and vecuronium groups had no significant changes in either plasma histamine concentrations or haemodynamic variables.
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Randomized Controlled Trial Clinical Trial
Effects of clonidine premedication on the pressor response to alpha-adrenergic agonists.
It has been suggested that postjunctional alpha 1-adrenoceptor mediated vasoconstriction is enhanced by clonidine. We have examined in humans if the pressor responses to noradrenaline and phenylephrine are enhanced by clonidine premedication. Seventy-seven patients were allocated randomly to either clonidine (n = 38) or control (n = 39) groups. ⋯ When a stable haemodynamic state was obtained, either noradrenaline 0.5 microgram kg-1 (n = 40) or phenylephrine 2 micrograms kg-1 (n = 37) was administered randomly i.v. as a bolus, while arterial pressure and heart rate were measured noninvasively at 1-min intervals for 10 min. Although noradrenaline caused significantly greater increases in mean arterial pressure (MAP) in the clonidine group (from 2 to 4 min after i.v. injection) compared with the control group, there were no significant differences in the mean maximal increment in MAP or area under the MAP curve between the two groups. However, i.v. phenylephrine produced a significantly greater increase in MAP from 2 to 7 min (P < 0.05), and greater mean maximal increase in MAP from the baseline value (21 (9) vs 14 (7) mm Hg; P < 0.05) in the clonidine than in the control group.(ABSTRACT TRUNCATED AT 250 WORDS)