British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
I.v. intraoperative ketoprofen in small children during adenoidectomy: a dose-finding study.
We have investigated if a low dose of ketoprofen (0.3 mg kg-1) i.v., provided as good analgesia with less adverse effects than higher doses (1.0 and 3.0 mg kg-1) in 220 children, aged 1-7 yr, undergoing adenoidectomy, in a prospective, randomized, double-blind, placebo-controlled, parallel group study. The postoperative analgesic effect was notable even after the lowest dose of ketoprofen. ⋯ None of the children experienced postoperative bleeding which would have required intervention or delayed discharge from hospital. This study confirms the efficacy and safety of intraoperative ketoprofen in children during adenoidectomy.
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Randomized Controlled Trial Comparative Study Clinical Trial
Recovery after halothane anaesthesia induced with thiopental, propofol-alfentanil or halothane for day-case adenoidectomy in small children.
We studied recovery from halothane anaesthesia in 93 children, aged 1-3 yr, undergoing day-case adenoidectomy. Children were allocated randomly to receive thiopental 5 mg kg-1 (group TH), alfentanil 10 micrograms kg-1 and propofol 3 mg kg-1 (group PAH) or 5% halothane (group HH) for induction of anaesthesia. In group TH, tracheal intubation was facilitated with succinylcholine (suxamethonium) 1.5 mg kg-1. ⋯ Children in group TH were more sedated during the first 30 min after anaesthesia than those in the two other groups (P < 0.05) while emergence-related delirium was more common in group HH than in group TH (P < 0.01). Well-being at home was similar in all groups. We conclude that induction of halothane anaesthesia with propofol-alfentanil or halothane provided more rapid recovery and earlier discharge than that with thiopental.
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Randomized Controlled Trial Clinical Trial
Nafamostat mesilate, a kallikrein inhibitor, prevents pain on injection with propofol.
We have examined the preventative effect of nafamostat mesilate, a kallikrein inhibitor, on pain on injection with propofol in a randomized, double-blind study. A control group (n = 110) and a nafamostat (n = 103) group received 5% glucose 0.02 ml kg-1 and nafamostat 0.02 mg kg-1 diluted with 5% glucose, respectively, followed 1 min later by 1% propofol injected at a rate of 200 mg min-1. ⋯ Mean nafamostat concentration 1 min after injection was 0.1 (SD 0.05) mumol litre-1, which is sufficient to inhibit plasma kallikrein activity. We conclude that pretreatment with nafamostat 0.02 mg kg-1 significantly reduced pain on propofol injection and this effect may be caused by a reduction in kallikrein activity.
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Comparative Study Clinical Trial Controlled Clinical Trial
Comparison of the effects of sevoflurane and isoflurane on arterial oxygenation during one lung ventilation.
We have compared the effects of sevoflurane and isoflurane on arterial oxygenation, heart rate and mean arterial pressure during one lung anaesthesia in a prospective, crossover study. We studied 28 patients undergoing oesophagogastrectomy, allocated alternatively to one of two groups. Patients in group I/S (n = 14) received 1 MAC (1.1%) of isoflurane in oxygen from induction until the end of 30 min of open chest one lung ventilation (OLV) in the lateral position. ⋯ In the subgroup of patients with pulmonary artery catheters (n = 12), we found a significant increase (P < 0.05) in derived shunt during sevoflurane anaesthesia. There was no significant difference in mixed venous saturation and cardiac output. We conclude that during one lung ventilation, the choice between sevoflurane and isoflurane did not significantly influence arterial oxygenation.
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A specific action against myocardial reperfusion injury of the oxygen paradox type was recently characterized for halothane after anoxic perfusion in isolated rat hearts and isolated cardiomyocytes. In this study, we have characterized the protective effects of the clinically available inhalation anaesthetics during reperfusion after ischaemia. In isolated, isovolumically beating rat hearts perfused at a constant flow (10 ml min-1, PO2 80 kPa) and paced at 350 beat min-1, we determined left ventricular developed pressure (LVDP) and release of creatine kinase (CKR) as indices of myocardial performance and cellular injury, respectively. ⋯ At 30 min of reperfusion, recovery of LVDP was improved to a similar extent by all anaesthetics (halothane 30 (9)%, enflurane 36 (9)%, isoflurane 33 (5)%, sevoflurane 30 (5)%, desflurane 36 (4)% of baseline values) compared with controls (13 (5)%; each P < 0.05). All inhalation anaesthetics protected against myocardial reperfusion injury, but showed differences in attenuation of cellular injury and functional recovery. These differences may suggest different protective mechanisms.