British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Does speed of intrathecal injection affect the distribution of 0.5% hyperbaric bupivacaine?
We have evaluated the influence of speed of intrathecal injection on lateral distribution of 0.5% hyperbaric bupivacaine. We studied 60 patients undergoing lower limb surgery who were placed in the lateral position with the operative side in the dependent position. After dural puncture (25-gauge Whitacre spinal needle), the needle aperture was turned towards the dependent side and 0.5% hyperbaric bupivacaine 8 mg was injected randomly at a rate of 0.02 ml s-1 (group slow, n = 30) or 0.25 ml s-1 (group fast, n = 30). ⋯ There were no differences between the groups. Forty-five minutes after patients were turned to the supine position, spinal anaesthesia was unilateral in 17 patients in group slow (56%) and in 13 patients in group fast (43%). We conclude that using extremely low speeds for intrathecal injection were not clinically advantageous in obtaining unilateral spinal anaesthesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Mivacurium compared with succinylcholine in children with liver disease.
We have compared mivacurium and succinylcholine in 27 paediatric patients with mild (Child's A) to moderate (Child's B) liver disease undergoing oesophagogastroduodenoscopy (OGD) and injection of oesophageal varices, with 10 healthy children receiving mivacurium for ENT procedures. With mivacurium 0.2 mg kg-1, the severity of liver disease did not correlate with duration of block compared with controls (time from bolus to T1 25%, P = 0.74; T1 25% to T4:T1 > 0.7, P = 0.545). However, initial recovery (time to T1 25%, P = 0.002) and overall recovery (bolus to T4:T1 > 0.7, P = 0.004) from mivacurium-induced neuromuscular block correlated inversely with pre-existing concentrations of plasma cholinesterase. Conditions for tracheal intubation at 2 min with mivacurium were comparable with conditions at 1 min with succinylcholine in the liver patients.
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Randomized Controlled Trial Clinical Trial
Oral granisetron prevents postoperative vomiting in children.
We have studied the efficacy of granisetron, a selective 5-hydroxytryptamine type 3 receptor antagonist, administered orally for the prevention of postoperative vomiting after tonsillectomy in children. In a randomized, double-blind, placebo-controlled study, 160 paediatric patients, ASA 1, aged 4-10 yr, received placebo or granisetron (20, 40 or 80 micrograms kg-1) (n = 40 each) orally, 1 h before surgery. ⋯ There were no clinically important adverse events. We conclude that preoperative oral granisetron, in doses more than 40 micrograms kg-1, was effective for the prevention of postoperative vomiting in children.
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Randomized Controlled Trial Comparative Study Clinical Trial
Saline as an alternative to air for filling the laryngeal mask airway cuff.
We have assessed a new method to evacuate saline completely from the laryngeal mask airway (LMA) cuff and tested the hypothesis that intracuff pressures, fibreoptic position and oropharyngeal leak pressures are similar for saline compared with air during nitrous oxide-oxygen anaesthesia. Eight size 4 LMA were inflated with saline 30 ml. After syringe evacuation, median residual weight was 0.56 (range 0.24-0.98) g; after additional manual cuff squeezing it was 0.26 (0.21-0.35) g; and after drying for 12 h at 60 degrees C with the valve open it was -0.02 (-0.05-0.04) g. ⋯ Oropharyngeal leak pressures were similar between groups. We conclude that the saline-inflated LMA cuff was reliably emptied and more stable in terms of intracuff pressures and possibly fibreoptic position. Filling the LMA cuff with saline is a viable option during laser surgery to the airway.
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Randomized Controlled Trial Comparative Study Clinical Trial
Haemodynamic and electroencephalographic response to insertion of a cuffed oropharyngeal airway: comparison with the laryngeal mask airway.
We have compared the cuffed oropharyngeal airway (COPA), a modified Guedel airway device with a specially designed cuff at its distal end, with the laryngeal mask airway (LMA), on haemodynamic and electroencephalographic (EEG) responses to insertion. In addition, we examined the haemodynamic and EEG changes during initiation of the effect-compartment controlled infusion. We studied 35 female patients undergoing ambulatory gynaecological surgery allocated randomly to received an LMA or COPA to manage the airway. ⋯ The effect-compartment controlled infusion of propofol caused only mild haemodynamic changes during induction. Changes in arterial pressure and heart rate after insertion were similar in both groups and not significantly different from baseline values before insertion. Changes in BIS after insertion were minor and similar between groups.