British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Double-blind comparison of sevofluran vs propofol and succinylcholine for tracheal intubation in children.
We have studied intubating conditions in 64 healthy children, aged 3-10 yr, undergoing adenotonsillectomy, in a double-blind, randomized study. Intubation was performed 150 s after induction using either 8% sevoflurane in nitrous oxide and oxygen or propofol 3-4 mg kg-1 with succinylcholine 2 mg kg-1. ⋯ The sevoflurane technique cost 3.62 +/- 0.55 Pounds to completion of tracheal intubation, significantly more (P < 0.001) than the cost of propofol-succinylcholine and isoflurane (2.04 +/- 0.54 Pounds) when based on actual amount of drug used. This cost increased to 4.38 +/- 0.05 Pounds when based on whole ampoules, which is significantly more than the cost of sevoflurane (P < 0.001).
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Randomized Controlled Trial Clinical Trial
Solvent for etomidate may cause pain and adverse effects.
We tested the hypothesis that the solvent for etomidate was a factor in the incidence of pain and other side effects after injection, and that these were associated with histamine release. Nine of 10 volunteers who received etomidate in a propylene glycol formulation reported moderate to severe pain on injection; only one of 10 subjects who received a lipid emulsion formulation reported mild pain (P < 0.05). The incidence of venous sequelae in the injected vein over the next 8 days was 50% in the propylene glycol group and 0% in the lipid emulsion group (P < 0.05). ⋯ In the lipid emulsion group, no volunteer had an increase in histamine concentrations > 1 ng ml-1. We conclude that etomidate formulated in propylene glycol may cause direct injury to vascular endothelium resulting in pain and venous sequelae, whereas etomidate in lipid emulsion does not. There was no relationship between pain or venous sequelae and histamine release.
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Randomized Controlled Trial Clinical Trial
Comparison of pentastarch and Hartmann's solution for volume preloading in spinal anaesthesia for elective caesarean section.
We studied 160 patients undergoing elective Caesarean section under spinal anaesthesia who received a preloading volume of 15 ml kg-1 of 10% pentastarch in 0.9% saline, or Hartmann's solution, in a prospective, randomized, double-blind study. We compared the incidence of spinal-induced hypotension in each group. Hypotension was defined as a decrease in systolic arterial pressure to less than 70% of baseline values or < or = 90 mm Hg, whichever was the greater. ⋯ Linear regression analysis showed that the only significant variable was type of fluid used. Blood glucose concentrations were not related to the presence of hypotension. We conclude that starches may be suitable for preloading in Caesarean section under spinal anaesthesia and provide an alternative to the aggressive use of vasoconstrictors.
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Randomized Controlled Trial Clinical Trial
Postoperative analgesia with i.v. patient-controlled morphine: effect of adding ketamine.
We have studied the effect of adding ketamine to i.v. morphine patient-controlled analgesia (PCA) for the treatment of pain after laparotomy. Thirty patients were allocated randomly to receive PCA with saline or ketamine in a double-blind, randomized study. Analgesia was started in the recovery room when visual analogue scale (VAS) scores were > 4. ⋯ VAS scores decreased significantly with time (P = 0.0001) and were similar (P = 0.3083) in both groups. Cumulative morphine consumption at 48 h was significantly lower in the ketamine group (28 mg) than in the control group (54 mg) (P = 0.0003). Nausea was less frequent in the ketamine group (P = 0.03).
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Randomized Controlled Trial Comparative Study Clinical Trial
A prospective, randomized comparison of preoperative and continuous balanced epidural or paravertebral bupivacaine on post-thoracotomy pain, pulmonary function and stress responses.
Both epidural and paravertebral blocks are effective in controlling post-thoracotomy pain, but comparison of preoperative and balanced techniques, measuring pulmonary function and stress responses, has not been undertaken previously. We studied 100 adult patients, premedicated with morphine and diclofenac, allocated randomly to receive thoracic epidural bupivacaine or thoracic paravertebral bupivacaine as preoperative bolus doses followed by continuous infusions. All patients also received diclofenac and patient-controlled morphine. ⋯ Areas under the plasma concentration vs time curves for cortisol and glucose were significantly lower in the paravertebral groups. Side effects, especially nausea, vomiting and hypotension, were troublesome only in the epidural group. We conclude that with these regimens, paravertebral block was superior to epidural bupivacaine.