British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Factors affecting assessment of cerebral autoregulation using the transient hyperaemic response test.
The transient hyperaemic response in the middle cerebral artery blood flow velocity on the release of brief compression of the ipsilateral common carotid artery has been validated as an indicator of cerebral autoregulation. We evaluated, in three stages, the effect of experimental factors such as duration of compression of the common carotid artery and magnitude of the decrease in blood flow velocity during common carotid artery compression on the transient hyperaemic response. In stage 1, 13 healthy volunteers underwent six transient hyperaemic response tests each; two tests each for either 3, 6 or 10 s duration of compression of the common carotid artery. ⋯ We conclude that experimental factors such as duration of common carotid artery compression and magnitude of the decrease in blood flow velocity during common carotid artery compression can significantly influence the transient hyperaemic response. These factors should be controlled if the transient hyperaemic response test is used for a comparison between repeated measurements. A compression time of 10 s and a compression ratio of 40% or more, allow maximum expression of the hyperaemic response in healthy volunteers.
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Meta Analysis
A qualitative systematic review of incisional local anaesthesia for postoperative pain relief after abdominal operations.
In a qualitative systematic review, we have evaluated randomized controlled trials (RCT) of incisional local anaesthesia compared with placebo or no treatment in the control of postoperative pain after open abdominal operations. Twenty-six studies with data from 1211 patients were considered appropriate for analysis. Five RCT considered inguinal herniotomy, four hysterectomy, eight cholecystectomy and nine studies a variety of surgical procedures. ⋯ Five of the cholecystectomy studies showed significant differences but questionable clinical importance and validity in three. In various other procedures results were inconsistent and in some of minor clinical importance. Except for herniotomy, there was a lack of evidence for effect of incisional local anaesthesia on postoperative pain and further standardized studies are needed before recommendations can be made.
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Randomized Controlled Trial Clinical Trial
Influence of timing of morphine administration on postoperative pain and analgesic consumption.
We have investigated if a pre-emptive dose of morphine, given 30 min before skin incision, influenced postoperative pain and morphine consumption after hysterectomy. In a prospective, randomized, double-blind, placebo-controlled clinical study, patients received morphine 0.3 mg kg-1 at induction of anaesthesia or 30 min later at skin incision. The primary endpoint was defined as 24-h morphine consumption via patient-controlled analgesia. We could not demonstrate any difference between the two groups in morphine consumption or pain scores, and we conclude that there was no evidence of pre-emptive analgesia in this study.
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Randomized Controlled Trial Clinical Trial
Granisetron-droperidol combination for the prevention of postoperative nausea and vomiting in female patients undergoing breast surgery.
We have compared the efficacy and safety of the combination granisetron-droperidol with each antiemetic alone in preventing postoperative nausea and vomiting (PONV) after breast surgery. In a randomized, double-blind study, 150 female patients received granisetron 3 mg, droperidol 1.25 mg or granisetron 3 mg with droperidol 1.25 mg (n = 50 each) i.v., immediately before induction of anaesthesia. ⋯ The incidence of PONV during the first 24 h after anaesthesia was 18% with granisetron, 38% with droperidol and 4% with the granisetron-droperidol combination (P < 0.05; overall Fisher's exact probability test). We conclude that the granisetron-droperidol combination was more effective than each antiemetic alone in the prevention of PONV in female patients undergoing breast surgery.
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Randomized Controlled Trial Comparative Study Clinical Trial
High-dose ondansetron regimen vs droperidol for morphine patient-controlled analgesia.
We have performed a randomized, double-blind study comparing droperidol and high-dose ondansetron mixed with morphine for patient-controlled analgesia (PCA). To detect a reduction in the incidence of postoperative nausea and vomiting from 55% to 20% with a power of 80% at the P < 0.05 level, 29 patients per group were required. We studied 60 healthy women undergoing abdominal hysterectomy, anaesthetized using a standard technique. ⋯ In group D, 24 patients did not vomit compared with 23 in group O. The only significant difference between the groups was increased morphine consumption in the ondansetron group up until 12 h after operation (P < 0.05), but by 24 h this difference was not significant. The ondansetron regimen was more expensive (at local prices) by a factor of 27, and our results suggested no clinical advantage over droperidol.