British journal of anaesthesia
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Single dose i.v. tropisetron in the prevention of postoperative nausea and vomiting after gynaecological surgery.
In a prospective, randomized, multicentre, double-blind, placebo-controlled study, we have compared the efficacy of a single i.v. dose of tropisetron 0.5 mg, 2 mg and 5 mg in the prevention of postoperative nausea and vomiting (PONV). We studied 385 ASA class I and II female patients undergoing abdominal or vaginal gynaecological surgery, including laparoscopy. ⋯ Compared with placebo, nausea was reduced from 55% to 46%, 34% and 46% (P = 0.25, P = 0.003, P = 0.22), and need for rescue treatment from 39% to 29%, 23% and 35% (P = 0.13, P = 0.017 and P = 0.59) for the same groups. Tropisetron 2 mg appeared to be the optimal dose for prophylaxis against PONV with a side-effect profile similar to that of placebo.
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We have compared the potency of vecuronium given to 12 smokers and 12 non-smokers during propofol-alfentanil-nitrous oxide anaesthesia. After obtaining individual dose-response curves, bolus doses of vecuronium were given to maintain neuromuscular block at 90-98% for 60 min. Adductor pollicis EMG was used to monitor neuromuscular block. ⋯ The dose of vecuronium to maintain 90-98% neuromuscular block was 25% higher in smokers than in non-smokers (96.80 vs 72.11 micrograms kg-1 h-1; P < 0.01). These data reflect the effects of smoking on neuromuscular block induced by vecuronium. The effect may be at the receptor level, although possible increased metabolism of vecuronium in smokers cannot be excluded.
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The Seldinger technique was developed using a plastic introducer through which introduction and manipulations of a silicone spinal catheter, an extradural stimulation lead or a small diameter fibreoptic scope are possible without the risk of damage to the vulnerable devices. It is not intended as a replacement of the standard technique of introducing a spinal catheter through a Tuohy needle in general anaesthetic practice. Silicone spinal catheters and stimulation leads are used for long-term therapy in intractable chronic pain and spasticity. ⋯ Neural damage or trauma did not occur with the Seldinger technique. The incidence of post-spinal headache was the same for both techniques. No further complications were noted.
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Randomized Controlled Trial Comparative Study Clinical Trial
A double-blind comparison of 0.25% ropivacaine and 0.25% bupivacaine for extradural analgesia in labour.
Ropivacaine is a new aminoamide local anaesthetic. Compared with bupivacaine, ropivacaine possesses a higher threshold for systemic toxicity and a high selectivity for sensory fibres. We have compared prospectively these two agents in a concentration of 0.25% for extradural analgesia in labour. ⋯ The ropivacaine group had a higher incidence of spontaneous vaginal delivery (70.59% vs 52.00%). There was no significant difference in neonatal outcome as assessed by Apgar scores, umbilical acid-base status and neurological and adaptive capacity score at 2 and 24 h after delivery. We conclude that ropivacaine and bupivacaine in a concentration of 0.25% produced comparable analgesia for pain relief of labour with no detectable adverse effect on the neonate.