British journal of anaesthesia
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Randomized Controlled Trial Comparative Study
Analgesia with sevoflurane during labour: ii. Sevoflurane compared with Entonox for labour analgesia.
We determined the optimal inspired sevoflurane concentration for use during labour as 0.8% in our previous study. This study compared sevoflurane at a concentration of 0.8% and Entonox((R)) (nitrous oxide 50%: oxygen 50%) for analgesia during labour in 32 healthy parturients. ⋯ We conclude that self-administered sevoflurane at subanaesthetic concentration (0.8%) can provide useful pain relief during the first stage of labour, and to a greater extent than Entonox. Although greater sedative effects were experienced with sevoflurane, it was preferred to Entonox.
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Randomized Controlled Trial Comparative Study
Haemodynamic effects of oxytocin given as i.v. bolus or infusion on women undergoing Caesarean section.
The cardiovascular effects of oxytocin in animal models and women undergoing Caesarean section include tachycardia, hypotension and decrease in cardiac output. These can be sufficient to cause significant compromise in high-risk patients. We aimed to find a simple way to decrease these risks whilst retaining the benefits of oxytocin in decreasing bleeding after delivery. Method. We recruited 30 women undergoing elective Caesarean section. They were randomly allocated to receive 5 u of oxytocin either as a bolus injection (bolus group) or an infusion over 5 min (infusion group). These women had their heart rate and intra-arterial blood pressure recorded every 5 s throughout the procedure. The haemodynamic data, along with the estimated blood loss, were compared between the groups. ⋯ We recommend that bolus doses should be used with caution, and further studies should ascertain if oxytocin is equally effective in reducing blood loss when given at a slower rate.
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Comparative Study Controlled Clinical Trial
Flow-related techniques for preoperative goal-directed fluid optimization.
Improved postoperative outcome has been demonstrated by perioperative maximization of cardiac stroke volume (SV) with fluid challenges, so-called goal-directed therapy. Oesophageal Doppler (OD) has been the most common technique for goal-directed therapy, but other flow-related techniques and parameters are available and they are potentially easier to apply in clinical practice. The objective of this investigation was therefore to use OD for preoperative SV maximization and compare the findings with a Modelflow determined SV, with an OD estimated corrected flow time (FTc), with central venous oxygenation ( Svo2 ) and with muscle and brain oxygenation assessed with near infrared spectroscopy (NIRS). ⋯ Preoperative SV optimization guided by OD for goal-directed therapy is preferable compared with Modelflow SV, FTc, NIRS and Svo2 until outcome studies for the latter are available.
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Randomized Controlled Trial
Pretreatment with remifentanil to prevent withdrawal after rocuronium in children.
Pain from rocuronium injection is a common side-effect reported to occur in 50-80% of the patients. This randomized, double-blind, placebo-controlled study was designed to evaluate the efficacy of pretreatment with i.v. remifentanil on prevention of withdrawal response during rocuronium injection in paediatric patients. ⋯ This study demonstrated that pretreatment with remifentanil 1 microg kg(-1) provided a safe and simple method for reducing the incidence of rocuronium-associated withdrawal movement with haemodynamic stability in children.