British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of desflurane and isoflurane in anaesthesia for dental surgery.
We studied 50 ASA I-II patients, aged 18-65 yr, undergoing elective orofacial surgery. Anaesthesia was induced with fentanyl and propofol, and maintained with 66% nitrous oxide in oxygen and either desflurane or isoflurane to compare recovery characteristics and cardiovascular stability. Cardiovascular responses to induction, intubation and incision were similar with both agents, although the increase in heart rate in response to intubation was less marked in the desflurane group. ⋯ Mean duration of anaesthesia was 46 (SD 17.9) min (range 25-89 min) in the desflurane group and 41 (11.5) (23-60) min in the isoflurane group. Times to extubation were 6.7 (2.1) (3-10) min and 11.3 (4.1) (5-23) min, to eye opening 6.8 (2.2) (3-11) min and 12.7 (6.9) (7-37) min, to stating date of birth 9.0 (2.3) (4-12) min and 15.0 (6.9) (8-39) and to discharge from the recovery room 45 (11.6) (22-80) min and 64 (20.9) (28-134) min, for the desflurane and isoflurane groups, respectively (all P < 0.0001). No serious complications occurred in any patient.
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Randomized Controlled Trial Clinical Trial
Visceral pain during caesarean section: effect of varying dose of spinal amethocaine.
The aim of this study was to determine how varying the dose of spinal amethocaine influences the incidence of visceral pain associated with exteriorization of the uterus after delivery. In a double-blind study, we examined the incidence of visceral pain in 40 parturients undergoing Caesarean section under spinal anaesthesia with amethocaine 8, 10, 12 or 14 mg in 2 ml of 5% glucose. ⋯ The incidence of visceral pain was lower in the 12-mg (P < 0.05) and 14-mg (P < 0.01) groups than in the 8-mg group, although there were no differences in maximum spread of analgesia and circulatory changes between the four groups. This study suggests that a slightly higher dose of spinal amethocaine (12-14 mg) is preferable for Caesarean section.
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Randomized Controlled Trial Comparative Study Clinical Trial
Quantitative evaluation of tourniquet leak during i.v. regional anaesthesia of the upper and lower limbs in human volunteers.
Although it is accepted that during i.v. regional anaesthesia (IVRA) local anaesthetic can leak under the tourniquet into the systemic circulation, no published study has evaluated this leak quantitatively. In volunteers, during two random sessions, we have simulated IVRA using standard techniques with a radiolabelled compound which is chemically similar to lignocaine and has comparable tissue distribution (0.1 mg of HIDA labelled with 100 muCi of 99mTc in 40 ml of saline). The decrease in radioactivity was measured with a gamma camera for the 20 min of tourniquet inflation and for the 20 min of washout after cuff deflation. ⋯ Moreover, in each of 10 volunteers, the leak was always greater for the lower than the upper limb. During the first 3 min after tourniquet deflation the loss of radioactivity was 58 (8) % of the maximal amount for the upper limb and 39 (8) % for the lower limb (P < 0.001). As the leak under the tourniquet was significantly greater for the lower than the upper limb, we conclude that IVRA for the lower limb can be associated more frequently with a shorter duration of successful anaesthesia and/or failure.
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Randomized Controlled Trial Comparative Study Clinical Trial
Recovery after electroconvulsive therapy: comparison of propofol with methohexitone anaesthesia.
We have studied prospectively 39 patients receiving a course of electroconvulsive therapy (ECT) for major depressive disorder; they were allocated randomly to receive either propofol or methohexitone for anaesthesia. Recovery after the third ECT treatment was assessed by finger tap and digit symbol substitution tests at 15, 30, 45, 60 and 90 min after induction. ⋯ There was no significant difference in psychometric recovery for drug type, duration of the seizure or initial severity of depression. These results suggest that the more rapid recovery rates noted with propofol in other procedures are not evident after electrically induced seizures.
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Randomized Controlled Trial Comparative Study Clinical Trial
Evaluation of an amethocaine gel preparation for percutaneous analgesia before venous cannulation in children.
We have evaluated the efficacy and safety of a preparation of 4% amethocaine gel in alleviating the pain of venous cannulation in children. In an initial open study of 148 children, clinically acceptable anaesthesia was achieved in 92% of cases. ⋯ There were no significant adverse effects noted in each group, although 37% of those children treated with amethocaine gel showed localized erythema at the application site. The results suggest that amethocaine gel has greater efficacy and a faster onset time than EMLA cream when used for this purpose in children.