British journal of anaesthesia
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Comparative Study Retracted Publication
Semi-invasive monitoring of cardiac output by a new device using arterial pressure waveform analysis: a comparison with intermittent pulmonary artery thermodilution in patients undergoing cardiac surgery.
Thermodilution technique using a pulmonary artery catheter (PAC) is a widely used method to determine cardiac output (CO). It is increasingly criticized because of its invasiveness and its unclear risk-benefit ratio. Thus, less invasive techniques for measuring CO are highly desirable. We compared a new, semi-invasive device (FloTrac/Vigileo) using arterial pressure waveform analysis for CO measurement in patients undergoing cardiac surgery with bolus thermodilution measurements. ⋯ In cardiac surgery patients, CO measured by a new semi-invasive arterial pressure waveform analysis device showed only moderate agreement with intermittent pulmonary artery thermodilution measurement.
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Randomized Controlled Trial
Premedication with controlled-release oxycodone does not improve management of postoperative pain after day-case gynaecological laparoscopic surgery.
Controlled-release (CR) oxycodone provides an option for the prevention of postoperative pain. We designed this randomized double-blinded placebo controlled study to evaluate the control of pain after premedication with CR oxycodone 15 mg in addition to ibuprofen 800 mg orally in day-case gynaecological laparoscopic surgery. ⋯ Oral premedication with CR oxycodone did not improve management of postoperative pain after day-case gynaecological laparoscopic surgery.
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Randomized Controlled Trial
Intrathecal morphine reduces breakthrough pain during labour epidural analgesia.
When using the combined spinal-epidural (CSE) technique for labour analgesia, parturients often experience breakthrough pain after the spinal medication has receded. We tested the hypothesis that a small dose of intrathecal morphine would reduce breakthrough pain. ⋯ The addition of small dose of morphine to the spinal component of the CSE technique improved the effectiveness of epidural labour analgesia and reduced the need for pain medications over 24 h, but resulted in a small increase in nausea.
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Propofol is thought to minimally depress myocardial function, but mainly to reduce blood pressure by vasodilation. Transthoracic tissue-Doppler echocardiography (TDE) is a novel, validated method of quantifying myocardial function. It provides new insight into myocardial function by measuring myocardial motion. We examined the effects of propofol upon myocardial function by measuring changes in left ventricle function by TDE. ⋯ The results indicate that myocardial contractile function is compromised concomitantly with reduced cyclic displacement after propofol dosing. Blood pressure declined accordingly. From these results, it is impossible to ascertain whether this was secondary to reduced cardiac filling or a consequence of a direct negative inotropic action of propofol, but it represents a left-shift of the Starling curve. The novel TDE yields new information on myocardial velocities and motion.
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Randomized Controlled Trial Comparative Study
Autonomic effects of epidural and intravenous fentanyl.
We tested the hypothesis that there is greater suppression of autonomic reflexes during general anaesthesia when fentanyl is administered epidurally than when it is given intravenously. ⋯ We conclude that during general anaesthesia, epidural fentanyl enhances antinociception by a spinal mechanism which can be detected by pupillary dilation but not by changes in arterial pressure or heart rate.