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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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of continuous and intermittent administration of extradural bupivacaine for analgesia after lower abdominal surgery.
We have compared intermittent bolus and continuous infusion of extradural local anaesthetic for pain relief in a randomized, double-blind study of 48 patients who underwent major abdominal gynaecological surgery. Each patient received 5 ml of 0.375% bupivacaine hourly, either as a bolus over 5 min or as a constant infusion. Patients who received the intermittent administration technique maintained a more extensive sensory block, reported marginally better analgesia and had a lower requirement for rescue medication. The intermittent bolus technique was not associated with an increase in side effects.
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Randomized Controlled Trial Clinical Trial
Effect of positive end-expiratory pressure on the incidence of venous air embolism and on the cardiovascular response to the sitting position during neurosurgery.
We have studied prospectively the effect of 10 cm H2O of PEEP on the incidence of venous air embolism and on the cardiovascular response to change from the supine to the seated position in a large neurosurgical population. Patients were allocated randomly to receive either PEEP (10 cm H2O, n = 45) or conventional (control, n = 44) ventilation. Cardiovascular and respiratory variables were measured in the supine and sitting positions, and monitoring included precordial Doppler probe, pulmonary artery pressure and expiratory carbon dioxide concentration. ⋯ Furthermore, pulmonary vascular resistance increased significantly only in the upright position in those undergoing ventilation with PEEP. The pulmonary artery wedge pressure to central venous pressure gradient did not attain negative values with PEEP or with upright positioning. We conclude that the use of PEEP during neurosurgical procedures performed in the sitting position should be abandoned as it does not decrease the incidence of venous air embolism but is associated with significant adverse cardiovascular effects.