British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Antagonism of vecuronium-induced neuromuscular block in patients pretreated with magnesium sulphate: dose-effect relationship of neostigmine.
We have investigated the dose-effect relationship of neostigmine in antagonizing vecuronium-induced neuromuscular block with and without magnesium sulphate (MgSO4) pretreatment. Neuromuscular block was assessed by electromyography with train-of-four (TOF) stimulation. First, we determined neostigmine-induced recovery in patients pretreated with MgSO4 (group A) or saline (group B) (n = 12 each). ⋯ Maximum assisted recovery was not influenced by MgSO4 pretreatment (27 (6)% in group A and 32 (6)% in group B) and time to maximum effect was comparable between groups: 6 (4-10) min and 7 (5-8) min, respectively. We conclude that neostigmine-induced recovery was attenuated in patients treated with MgSO4. This was mainly a result of slower spontaneous recovery and not decreased response to neostigmine.
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Randomized Controlled Trial Clinical Trial
Influence of bolus size on efficacy of postoperative patient-controlled analgesia with piritramide.
We have examined the influence of bolus size on efficacy, opioid consumption, side effects and patient satisfaction during i.v. patient-controlled analgesia (PCA) in 60 patients (ASA I-II, aged 32-82 yr) after abdominal surgery. Patients were allocated randomly, in a double-blind manner, to receive PCA with a bolus dose of either piritramide 0.75 mg or 1.5 mg (lockout 5 min) for postoperative pain control. ⋯ There were no significant differences in the number of applied bolus doses, pain scores, pain relief (VAS), sedation, nausea, pruritus and patient satisfaction. We conclude that a PCA regimen with a bolus dose of piritramide 0.75 mg and a lockout time of 5 min was effective in the treatment of postoperative pain, but did not reduce the occurrence of side effects.
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Randomized Controlled Trial Clinical Trial
Effect of sevoflurane concentration on inhalation induction of anaesthesia in the elderly.
We have conducted a randomized, double-blind comparison of 4% and 8% sevoflurane for induction of anaesthesia in unpremedicated patients aged more than 60 yr. Sevoflurane was inhaled in 50% nitrous oxide using a vital capacity breath technique, and mean, systolic and diastolic arterial pressures and heart rate were monitored continuously using a Finapres cuff. In the 8% sevoflurane group, time to successful laryngeal mask insertion was significantly shorter (mean 168 (SD 34) s vs 226 (62) s; P < 0.01) and achieved more often at the first attempt than in the 4% sevoflurane group. ⋯ No patient had apnoea lasting longer than 1 min. A total of 69% of patients described induction as pleasant and 85% would choose to have it again. We conclude that compared with 8% sevoflurane, the use of 4% sevoflurane in the elderly resulted in greater cardiovascular stability but at the cost of prolonged and occasionally unsuccessful induction.
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Randomized Controlled Trial Clinical Trial
A low concentration of nitrous oxide reduces dyspnoea produced by a combination of hypercapnia and severe elastic load.
We have measured how a low concentration of nitrous oxide affected respiratory sensation and ventilation. Severe dyspnoea was induced in nine normal subjects by a combination of hypercapnia and inspiratory elastic load (50 cm H2O litre-1). Subjects were asked to rate their sensation of respiratory discomfort using a visual analogue scale (VAS) while breathing either 20% nitrous oxide or 20% nitrogen gas mixture. ⋯ Inhalation of 20% nitrous oxide reduced the sensation of respiratory discomfort from a median VAS score of 6.5 (range 5.0-8.1) before inhalation to 3.6 (2.4-5.9) during inhalation (P < 0.05). There was no significant change in minute ventilation but tidal volume increased during inhalation of 20% nitrogen did not alter VAS scores or ventilatory variables. We found that a low concentration of nitrous oxide greatly alleviated the intensity of dyspnoea without changing respiratory load compensation.
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Comparative Study Clinical Trial Controlled Clinical Trial
Predicting outcome after cardiac surgery: comparison of global haemodynamic and tonometric variables.
To compare how outcome can be predicted from global haemodynamic compared with regional perfusion-related variables (gastric intramucosal pH (pHi) and intramucosal-arterial PCO2 difference (delta PCO2)), we measured global haemodynamics, gastric pHi and delta PCO2 in 68 haemodynamically compromised patients after cardiac surgery on admission to the intensive care unit (ICU) and 12 h later. Overall mortality rate in the ICU was 19.1%. ⋯ Our data showed that global, routinely monitored, haemodynamic variables are better early predictors of outcome after cardiac surgery than regional, tonometric variables. This conclusion does not support hypoperfusion of the gastrointestinal tract as an early determinant of outcome after cardiac surgery.