British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Antiemetic prophylaxis in cardiac surgery: comparison of metoclopramide and ondansetron.
We have compared the effectiveness of ondansetron (115 patients) and metoclopramide (101 patients) for prevention of postoperative nausea and vomiting in patients undergoing cardiac surgery involving cardiopulmonary bypass. In a prospective, randomized, controlled, double-blind study, patients received oral ondansetron 16 mg or oral metoclopramide 10 mg, 1-2 h before surgery. ⋯ Compared with the metoclopramide group, the ondansetron group had a higher incidence of nausea (49.6% vs 33.7%; P < 0.05) and vomiting (42.6% vs 24.8%; P < 0.01). There was no difference between groups in the number of patients who accepted postoperative antiemetics (ondansetron 43.4% vs metoclopramide 32.6%) and there was no difference in the incidence of symptoms of moderate or severe nausea.
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Case Reports
Malposition of the epiglottis after tracheal intubation via the intubating laryngeal mask.
The intubating laryngeal mask has been reported to be a successful method of tracheal intubation although advancement of the tracheal tube via the laryngeal inlet into the trachea cannot be seen. Damage to the larynx or other tissues may occur during blind passage of a tracheal tube. We report a case in which the tracheal tube, advanced blindly, tucked the epiglottis into the laryngeal inlet, resulting in oedema of the epiglottis. This case illustrates the potential for airway obstruction after extubation when using the intubating laryngeal mask as a blind intubation guide.
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Setting an appropriate positive end-expiratory pressure (PEEP) value is determined by respiratory mechanics, gas exchange and oxygen transport. As these variables may be optimal at different PEEP values, a unique PEEP value may not exist which satisfies both the demands of minimizing mechanical stress and optimizing oxygen transport. In 15 surfactant-deficient piglets, PEEP was increased progressively. ⋯ In the lavage model, the lower inflection point of the PV curve may reflect opening pressure rather than the pressure required to keep the recruited lung open. Recruitment takes place together with a change in the elastic properties of the already open parts of the lung. No single PEEP level is optimal for both oxygen transport and reduction of mechanical stress.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Rapacuronium for modified rapid sequence induction in elective caesarean section: neuromuscular blocking effects and safety compared with succinylcholine, and placental transfer.
We have compared rapacuronium 2.5 mg kg-1 (n = 20) with succinylcholine 1.5 mg kg-1 (n = 22) in a multicentre, blinded, randomized study in full-term parturients undergoing elective Caesarean section under general anaesthesia. Thiopental 5 mg kg-1 was given i.v. followed by the neuromuscular blocking agent. Sixty seconds later intubation was performed. ⋯ At delivery (17.7 (3.2) min), mean maternal plasma concentrations of rapacuronium were 9041.4 (1259.1) ng ml-1 and 506.4 (24.9) ng ml-1 for Org 9488 (the main metabolite). Corresponding values for umbilical venous plasma were 808.0 (92.1) ng ml-1 and 59.1 (6.5) ng ml-1, and for umbilical arterial plasma, 361.4 (56.4) ng ml-1 and 29.7 (4.6) ng ml-1, respectively. Umbilical venous to maternal venous ratios for rapacuronium and Org 9488 were 8.8% (1.3)% and 10.2 (1.7)%, respectively.
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Randomized Controlled Trial Comparative Study Clinical Trial
Combined spinal-epidural analgesia in labour: comparison of two doses of intrathecal bupivacaine with fentanyl.
We have compared intrathecal bupivacaine 1.25 mg and fentanyl 25 micrograms (group A) with bupivacaine 2.5 mg and fentanyl 25 micrograms (group B), for combined spinal-epidural analgesia in 49 labouring parturients in a prospective, randomized, double-blind study. Onset and quality of analgesia were similar in both groups, with median visual analogue scale pain scores of 0 achieved in 5-10 min. Median duration of analgesia was longer in group B (median 120 (range 90-120) min) compared with group A (75 (75-105) min) (P = 0.013). ⋯ Patient-midwife satisfaction scores and other side effects were similar. We conclude that intrathecal bupivacaine 1.25 mg with fentanyl 25 micrograms provided analgesia of similar onset and quality compared with bupivacaine 2.5 mg and fentanyl 25 micrograms. Although the duration of analgesia was shorter, the incidences of motor block and hypotension were less with the smaller dose.