British journal of anaesthesia
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Randomized Controlled Trial Multicenter Study Clinical Trial
A multicentre comparison of the costs of anaesthesia with sevoflurane or propofol.
Day-case anaesthesia requires rapidly eliminated anaesthetics which are relatively expensive. This multinational, multicentre European study assessed the relative costs of propofol or sevoflurane anaesthesia in 211 patients. Anaesthesia was induced and maintained with propofol in group 1, with propofol and sevoflurane in group 2, and with sevoflurane in group 3. ⋯ Anaesthetic drug wastage and disposable costs were highest in group 1 and lowest in group 3. Consequently, total costs were highest in group 1 ($31.9 (0.9)) compared with groups 2 ($19.7 (0.9)) and 3 ($18.8 (0.9)). Although we observed increased nausea and vomiting in groups 2 and 3 and reduced patient satisfaction in group 3, these differences should be balanced against the greater cost of propofol anaesthesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of sevoflurane-nitrous oxide and propofol-alfentanil-nitrous oxide anaesthesia for minor gynaecological surgery.
We studied 44 patients undergoing minor gynaecological surgery, anaesthetized in random order with sevoflurane-nitrous oxide or propofol-alfentanil-nitrous oxide. Operating conditions, recovery and postoperative nausea and vomiting (PONV) were assessed. For postoperative analgesia, all patients were given ketoprofen 100 mg rectally at the end of anaesthesia. ⋯ Patients given propofol woke up (3.5 vs 6.5 min), became orientated (5.0 vs 7.5 min) and were able to walk (57 vs 69 min) significantly (P < 0.05) earlier than those given sevoflurane, but there were no differences in times to achieve home readiness (166 vs 149 min) or in psychomotor recovery between the two groups. Intrauterine bleeding and PONV were more common with sevoflurane (incidence of PONV 64%) than with propofol anaesthesia (incidence of PONV 5%). We conclude that propofol-alfentanil is preferable to sevoflurane in ultra-short anaesthesia for minor gynaecological surgery.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of ondansetron and cyclizine for prevention of nausea and vomiting after day-case gynaecological laparoscopy.
We have compared ondansetron 4 mg i.v. and cyclizine 50 mg i.v., in a double-blind, randomized, placebo-controlled study for the prevention of postoperative nausea and vomiting (PONV) for 24 h after day-case gynaecological laparoscopy. Compared with placebo (n = 58), ondansetron (n = 60) and cyclizine (n = 57) reduced significantly the incidence of moderate or severe nausea (30% and 23% vs 52%; P = 0.02 and P = 0.001, respectively) and requirement for escape antiemetic (28% and 16% vs 47%; P = 0.04 and P < 0.001, respectively) before discharge from hospital. ⋯ For diagnostic laparoscopy (n = 74), fewer patients received escape antiemetic after cyclizine than after ondansetron (4% vs 37%; P < 0.01); for laparoscopic sterilization (n = 101), both antiemetics were equally effective. Ondansetron and cyclizine both reduced severe and moderate nausea and the need for antiemetic therapy after day-case gynaecological laparoscopy.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of breathing methods for inhalation induction of anaesthesia.
We studied healthy female patients, allocated randomly to three breathing regimens for induction of anaesthesia using sevoflurane and oxygen from a co-axial Mapleson D breathing system and a mask, to test the hypothesis that rebreathing reduces the incidence of apnoea associated with loss of consciousness. The non-rebreathing group received sevoflurane in oxygen 6 litre min-1 from the start, doubling in concentration from 0.5% to 8% every 3 breaths. The second group received oxygen 6 litre min-1 for 1 min before sevoflurane was introduced, and the third group received oxygen 3 litre min-1 for 1 min before sevoflurane. ⋯ Apnoea occurred in five of 15 patients who did not receive oxygen before sevoflurane and in four of 13 who received oxygen 6 litre min-1 (P < 0.05). No patient showed a reduction in pulse oximeter saturation. We conclude that inhalation induction of anaesthesia can be performed reliably in approximately 3 min using sevoflurane in oxygen 3 litre min-1.
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Randomized Controlled Trial Clinical Trial
Midazolam premedication and thiopental induction of anaesthesia: interactions at multiple end-points.
We have studied the effects of midazolam premedication on multiple anaesthetic end-points (hypnotic, loss of verbal contact (LVC); motor, dropping an infusion flex or bag (DF); analgesic, loss of reaction to painful stimulation (LRP); and EEG, attainment of burst suppression (BUR)) during induction by slow thiopental infusion at a rate of 55 mg kg-1 h-1. Patients received midazolam 0.05 mg kg-1 i.v. (group TM, n = 12) or no midazolam (group T0, n = 13). ED50 and ED95 values and group medians for times and doses at the end-points were measured. ⋯ There were no such increases for LVC or BUR. The interaction between midazolam and thiopental varied with the anaesthetic end-point and may also depend on the dose of thiopental. Our data suggest that the mechanism of interaction between midazolam premedication and thiopental was different for motor effects or analgesia (DF, LRP) compared with hypnotic effects or cortical depression (LVC, BUR), in agreement with the different central nervous system substrates underlying these distinct anaesthetic end-points.