British journal of anaesthesia
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We studied 107 patients aged over 65 years undergoing urgent or emergency laparotomy. Aspects of preoperative assessment, perioperative management and postoperative care were analysed by multiple logistic regression to determine the factors that predicted hospital survival. We determined which factors influenced anaesthetists' prediction that patients would survive. ⋯ We obtained a model that accounted for 93% of the variability in the likelihood of survival. Age and ASA status were significant predictors of survival (P < 0.05), and of anaesthetists' prediction of mortality both before and after operation. Several other factors were significant determinants of survival but were not determinants of the anaesthetist's opinion regarding survival.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Comparison of remifentanil in combination with isoflurane or propofol for short-stay surgical procedures.
There are few data in the literature that describe the use of remifentanil when administered as a component of an inhalation or total i.v. anaesthetic (TIVA) technique. We studied 251 male and female patients, aged 18-75 years, ASA I-II, undergoing inguinal hernia repair, arthroscopic knee surgery or varicose vein surgery of at least 30 min duration without premedication. Patients were randomized to receive a remifentanil loading dose of 1.0 microgram kg-1 followed by a continuous infusion of 0.5 microgram kg-1 min-1 in combination with isoflurane (end-tidal concentration 0.6%), (Group I, n = 115) or propofol (initial infusion rate 9 mg kg-1 h-1 reduced to 6 mg kg-1 h-1 after 10 min), (Group P, n = 118). ⋯ At the insertion of the last suture, the remifentanil infusion and concomitant anaesthetic were switched off simultaneously. Times to spontaneous respiration, adequate respiration and tracheal extubation were significantly shorter in group I compared with group P (6.4 min vs 7.6 min, P < 0.01; 7.6 min vs 9.3, P < 0.003; 7.8 min vs 9.5 min, P < 0.015). Overall mean systolic blood pressures during surgery were greater in group P compared with group I (P < 0.05) but the absolute differences were clinically insignificant (4-5 mm Hg).
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Randomized Controlled Trial Comparative Study Clinical Trial
Postoperative hypoxaemia: continuous extradural infusion of bupivacaine and morphine vs patient-controlled analgesia with intravenous morphine.
We carried out a randomized prospective study in 60 patients who had undergone major abdominal surgery for cancer. For postoperative pain control, 30 patients received continuous extradural infusion of 0.125% bupivacaine 12.5 mg h-1 and morphine 0.25 mg h-1 (EXI group) and 30 received patient-controlled analgesia (PCA) with intravenous morphine (1 mg bolus, 5-min lock-out and maximum dose 20 mg 4h-1). Both groups had general anaesthesia. ⋯ Episodes of moderate desaturation (90% > SpO2 85%) were more frequent in the EXI group than in the PCA group (P < 0.05). Pain scores were lower in the EXI group compared with the PCA group at rest and while coughing (P < 0.05). No significant difference was found for patient sedation and satisfaction.
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Ropivacaine is considered safer than bupivacaine, on the basis of experimental and human data that indicate a lower systemic toxicity. Here we report the occurrence of a single seizure after i.v. administration of ropivacaine 120 mg intended for extradural block in a patient having postpartum, tubal ligation. The only prodromal symptom was nervousness, and the only cardiovascular manifestation was sinus tachycardia. Systemic toxicity, although less than that expected with bupivacaine, can occur with ropivacaine.