British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Spinal anaesthesia for paediatric day-case surgery: a double-blind, randomized, parallel group, prospective comparison of isobaric and hyperbaric bupivacaine.
We have compared bupivacaine 5 mg ml-1, either isobaric in saline 0.9% or hyperbaric in 8% glucose, for spinal anaesthesia in 100 children, aged 2-115 months, in a double-blind, randomized, parallel group, prospective study. Children were premedicated with diazepam 0.5 mg kg-1 orally. Seventy-two children were sedated before, and 25 children after, lumbar puncture, with either propofol or thiopental (thiopentone). ⋯ Etilefrin was administered to one child to treat hypotension and atropine to one child to treat bradycardia. The study gave an impression of a delayed onset time of spinal block, as most of the nine children who required either fentanyl or a sedative for a mild reaction to skin incision had complete block when transferred to the recovery room after operation. Five children developed a mild, position-dependent headache.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of epidural bolus administration of 0.25% bupivacaine and 0.1% bupivacaine with 0.0002% fentanyl for analgesia during labour.
We have compared analgesia during labour provided by two epidural drug regimens, in a double-blind, randomized, controlled study. Group A received 10-ml bolus doses of 0.1% bupivacaine with fentanyl 2 micrograms ml-1 while group B received 0.25% plain bupivacaine 10 ml. ⋯ Duration of labour and time from insertion of the epidural to delivery was similar in both groups, but in group A, duration of the second stage was significantly shorter (P = 0.0003; 95% confidence interval (CI) -1.17, -0.27 h) and the incidence of forceps delivery was lower (P = 0.032). Maternal satisfaction with epidural analgesia, as assessed by VAS, was higher in group A (P = 0.04; 95% CI -0.001, 10.001).
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Randomized Controlled Trial Clinical Trial
Prophylactic antiemetic therapy with granisetron in women undergoing thyroidectomy.
We have evaluated the efficacy and safety of granisetron, a selective 5-hydroxytryptamine type-3 receptor antagonist, for the prevention of postoperative nausea and vomiting (PONV) in women undergoing thyroidectomy. In a prospective, randomized, placebo-controlled, double-blind study, 100 ASA I patients, aged 30-57 yr, received placebo or granisetron at three different doses (20, 40 or 100 micrograms kg-1) (n = 25 each), i.v., immediately before induction of anaesthesia. A standard general anaesthetic technique was used. ⋯ There were no clinically important adverse events in any group. We conclude that granisetron 40 micrograms kg-1 was an effective antiemetic for the prevention of PONV after thyroidectomy. Increasing the dose to 100 micrograms kg-1 provided no further benefit.
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Randomized Controlled Trial Comparative Study Clinical Trial
Patient-controlled interscalene analgesia with ropivacaine after major shoulder surgery: PCIA vs PCA.
We have compared the efficacy of patient-controlled interscalene analgesia (PCIA) using ropivacaine with patient-controlled analgesia (PCA) using nicomorphine in 60 patients (n = 30 in each group), in a prospective, randomized study. In both groups, all patients received interscalene block with 0.75% ropivacaine before induction of anaesthesia. Six hours after interscalene block, patients in group PCIA received continuous infusion of 0.2% ropivacaine at a rate of 5 ml h-1 with a bolus dose of 3 or 4 ml and a lockout time of 20 min; patients in group PCA received continuous infusion of nicomorphine 0.5 mg h-1 and a bolus dose of 2 or 3 mg with a lockout time of 20 min. ⋯ Nausea and pruritus occurred significantly more frequently in group PCA. Patient satisfaction was greater in group PCIA. We conclude that the use of 0.2% ropivacaine using PCIA was an efficient way of managing pain after major shoulder surgery and compared favourably with PCA nicomorphine in terms of pain relief, side effects and patient satisfaction.
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Muscarinic acetylcholine signalling plays major roles in regulation of consciousness, cognitive functioning, pain perception and circulatory homeostasis. Halothane has been shown to inhibit m1 muscarinic signalling. However, no comparative data are available for desflurane, sevoflurane or isoflurane, nor have the anaesthetic effects on the m3 subtype (which is also prominent in the brain) been studied. ⋯ Absence of interference with AT1A signalling and intracellular pathways suggest that the effects of anaesthetics on muscarinic signalling most likely result from interactions with the m1 or m3 receptor molecule. Multiple interaction sites with different affinities may explain the biphasic response to desflurane. Anaesthetic-specific effects on closely related receptor subtypes suggest defined sites of action for volatile anaesthetics on the receptor protein.