British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Effect of dexamethasone on postoperative emesis and pain.
In this double-blind, randomized, placebo-controlled study, we have evaluated the effect of preoperative administration of dexamethasone on postoperative vomiting and pain in 60 women undergoing general anaesthesia for major gynaecological surgery. Dexamethasone 10 mg (group D) or saline (group S) was administered i.v. in a double-blind manner during induction of anaesthesia. ⋯ Six patients in group D and 19 in group S experienced vomiting at least once within the 24-h postoperative period; dexamethasone was effective in reducing the overall incidence of vomiting from 63.3% to 20.0% (P < 0.01). Other variables were similar between the groups, and the influence of dexamethasone on postoperative pain was minimal.
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Multicenter Study
Mast cell tryptase in anaesthetic anaphylactoid reactions.
Increased concentrations of mast cell tryptase are a highly sensitive indicator of anaphylactic reactions during anaesthesia. We obtained serum specimens from 350 patients after possible anaphylactic reactions during anaesthesia. Serum was collected from patients in our own institution (27), and transported by mail and courier from other hospitals in response to a request in the medical literature (323). ⋯ Seven of 143 patients whose mast cell tryptase concentrations were not increased at appropriate sampling times had positive tests for IgE antibodies, and in 33 of 158 patients with increased mast cell tryptase concentrations no IgE antibodies were detected. We conclude that increased mast cell tryptase concentrations are a valuable indicator of an anaphylactic reaction during anaesthesia. Their presence favours an IgE-mediated cause but does not always distinguish between anaphylactoid and anaphylactoid reactions, and patients in whom mast cell tryptase concentrations are not increased still require skin testing.
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Clinical Trial Controlled Clinical Trial
Minimum local analgesic concentration of extradural bupivacaine increases with progression of labour.
We have used the technique of double-blind sequential allocation to quantify the minimum local analgesic concentration (MLAC) of extradural bupivacaine for women in early (median cervical dilatation 2 cm) and late (median cervical dilatation 5 cm) labour. The first bolus was 20 ml of the bupivacaine test solution. The concentration was determined by the response of the previous woman to a higher or lower concentration of bupivacaine according to up and down sequential allocation. ⋯ In early labour, the MLAC of bupivacaine was 0.048% w/v (95% confidence intervals (CI) 0.037-0.058% w/v), and 0.140% w/v (95% CI 0.132-0.150% w/v) in the late group. The MLAC of bupivacaine in late labour was greater by a factor of 2.9 (95% CI 2.7-3.2) compared with the MLAC in early labour (P < 0.0001, 95% CI difference 0.08-0.11). We conclude that advancing labour requires an increased concentration of extradural bupivacaine for pain relief.
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We have studied prospectively the clinical course and serum concentrations of thromboxane B2 (TxB2) and leukotriene B4 (LTB4) in patients developing adult respiratory distress syndrome (ARDS) after oesophagectomy. The clinical course was assessed according to a validated ARDS score, and intra- and postoperative measurements of TxB2 and LTB4 in pre- and post-pulmonary blood were performed in 18 patients undergoing oesophagectomy for oesophageal carcinoma and 11 control patients undergoing thoracotomy and pulmonary resection. Six of 18 patients undergoing oesophagectomy, but no control patient, developed ARDS. ⋯ Only patients with ARDS had a significant postoperative increase in post-pulmonary, but not pre-pulmonary, TxB2 concentrations (P < 0.05 vs patients without ARDS). This study provides evidence that TxA2, originating from the lungs, was associated with the development of ARDS after oesophageal resection. In view of the high incidence of ARDS after oesophagectomy (10-30%), prophylactic treatment of patients undergoing oesophageal resection with clinically applicable thromboxane synthetase inhibitors may be warranted.