British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Effect of clonidine pre-medication on propofol requirements during lower extremity vascular surgery: a randomized controlled trial.
Pre-medication with clonidine reduces the requirement for volatile agents during general anaesthesia. This may also be true for anaesthesia with propofol, but the amount of dose reduction has not been measured. Because clonidine also affects cardiac output and thus regional blood flow it could alter the pharmacokinetics of propofol. This randomized, double-blind placebo-controlled trial aimed to study the effect of clonidine pre-medication on dose requirement for propofol during lower extremity vascular surgery using the bispectral index (BIS) as a measure of anaesthetic depth. ⋯ Pre-medication with clonidine reduces the requirement for propofol, which is a pharmacokinetic effect and not a pharmacodynamic central sedative effect.
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Comparative Study
Use of a stimulating catheter for total knee replacement surgery: preliminary results.
There is continuing debate as to whether the use of electrical stimulation that aids in localizing nerves is also beneficial for optimizing placement of nerve catheters and lead to improved clinical outcomes, such as reductions in pain scores and opioid consumption. ⋯ The practical advantages of the stimulating catheter, as reported by previous investigators, were not obvious in this clinical situation. In terms of outcome measures such as pain scores and morphine consumption, we found no significant differences between stimulating and non-stimulating catheters.
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Randomized Controlled Trial Comparative Study Clinical Trial
Propofol injection pain in children: a prospective randomized double-blind trial of a new propofol formulation versus propofol with added lidocaine.
The incidence of pain on injection of propofol remains unacceptably high in children, despite various strategies to reduce it. A new drug formulation of propofol has, in adult studies, been reported to cause less injection pain compared with other propofol solutions. The aim of the present prospective randomized double-blind clinical trial was to compare the incidence of pain-free injection following the use of this new formulation with that following the use of propofol with added lidocaine in children undergoing day case surgery. ⋯ A new MCT-LCT propofol formulation as a plain solution was associated with a higher incidence of injection pain than LCT propofol with added lidocaine when used for induction of anaesthesia in children.
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We present a case report of severe localized infection after continuous popliteal sciatic nerve block. The report highlights the importance of meticulous asepsis and possibly limiting the duration of catheter use.
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Randomized Controlled Trial Comparative Study Clinical Trial
Randomized comparison of three methods of induction of anaesthesia with sevoflurane.
Rebreathing will occur if a low gas flow and a Mapleson D circuit are used to induce anaesthesia with a volatile anaesthetic agent. This has the advantage that it allows ventilation to be sustained when consciousness is lost, and specific manoeuvres such as breath-holding or vital capacity breaths are not needed to facilitate induction of anaesthesia. However, if the fresh gas flow were too small, this would slow induction by limiting the rate of delivery of the anaesthetic agent. To assess the impact of fresh gas flow and rebreathing, we compared induction using sevoflurane 8% given by three different methods. ⋯ In adult patients allowed to breathe normally, prompt and consistent inhalation induction of anaesthesia with sevoflurane is obtained when fresh gas flow is limited to 6 litre min(-1) from a Mapleson D circuit, but smaller flows are impractical.