British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Dexamethasone reduces nausea and vomiting after laparoscopic cholecystectomy.
We have evaluated the antiemetic effect of i.v. dexamethasone compared with saline in the prevention of nausea and vomiting after laparoscopic cholecystectomy. We studied 90 patients requiring general anaesthesia for laparoscopic cholecystectomy, in a randomized, double-blind, placebo-controlled study. The dexamethasone group (n = 45) received dexamethasone 8 mg i.v. and the saline group received saline 2 ml i.v. at induction of anaesthesia. ⋯ We found that 10% of patients in the dexamethasone group compared with 34% in the saline group reported vomiting (P < 0.05). Of note, the total incidence of nausea and vomiting was 23% in the dexamethasone group and 63% in the saline group (P < 0.001). We conclude that dexamethasone 8 mg significantly decreased the incidence of nausea and vomiting after laparoscopic cholecystectomy.
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Randomized Controlled Trial Comparative Study Clinical Trial
Ondansetron and droperidol in the prevention of postoperative nausea and vomiting.
We have performed a prospective, randomized, double-blind clinical study to assess the efficacy of ondansetron, droperidol, or both, in preventing postoperative emesis. We studied 242 patients undergoing biliary or gynaecological surgery under general anaesthesia. ⋯ Groups 2 and 4 had greater sedation scores than group 1 during the first 3 h (P < 0.01). We conclude that both droperidol and ondansetron showed a significant antiemetic effect, ondansetron was not significantly better than droperidol, and the combination of droperidol and ondansetron was better than droperidol but no better than ondansetron alone.
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Randomized Controlled Trial Clinical Trial
Posterior epidural space depth: safety of the loss of resistance and hanging drop techniques.
We have compared skin to epidural space distance (SED) and tip to tip distance (TTD), a measure of posterior epidural space depth (PESD), in 40 patients with a 27-gauge Whitacre needle after identification of the epidural space using the hanging drop (HD) or loss of resistance (LOR) to air technique. After the LOR technique, TTD was found to be 2 mm greater than that after the HD technique, whereas SED was the same. We conclude that identification of the epidural space can be performed successfully with both techniques, but with a diminished risk of dural damage after LOR compared with the HD technique.
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Randomized Controlled Trial Clinical Trial
Sevoflurane anaesthesia causes a transient decrease in aquaporin-2 and impairment of urine concentration.
Sevoflurane anaesthesia is occasionally associated with polyuria, but the exact mechanism of this phenomenon has not been clarified. Aquaporin-2 (AQP2) is an arginine vasopressin (AVP)-regulated water channel protein localized to the apical region of renal collecting duct cells and is involved in the regulation of water permeability. To elucidate the effect of sevoflurane anaesthesia on urine concentration and AQP2, we have compared serum and urinary concentrations of AVP, AQP2 and osmolar changes during sevoflurane and propofol anaesthesia. ⋯ Although urinary AQP2 excretion in the propofol group increased together with changes in plasma and urinary AVP, urinary AQP2 was significantly lower at 90 min in the sevoflurane group. Urine osmolality in the sevoflurane group also showed a transient but significant decrease in parallel with suppression of AQP2. Our data suggest that sevoflurane anaesthesia transiently produced an impaired AQP2 response to an increase in intrinsic AVP.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Comparison of 0.25% S(-)-bupivacaine with 0.25% RS-bupivacaine for epidural analgesia in labour.
We have compared the efficacy of 0.25% S(-)-bupivacaine with 0.25% RS-bupivacaine in providing epidural analgesia for labour in a randomized, multicentre, double-blind study. Analgesia was initiated with 10 ml of the study solution and maintained with 10-ml top-ups. We studied 137 women and treatments were found to be equivalent for onset, duration and quality of block. ⋯ However, median duration of pain relief from the first top-up was 82 (range 3-164) min for S(-)-bupivacaine and 76 (22-221) min for RS-bupivacaine. There were no significant differences in the quality of analgesia, as assessed by the investigators. There were no significant differences in the extent of sensory block, percentage of patients with motor block or incidence of adverse events.