British journal of anaesthesia
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Randomized Controlled Trial
Combination of opioid agonist and agonist-antagonist: patient-controlled analgesia requirement and adverse events among different-ratio morphine and nalbuphine admixtures for postoperative pain.
Nalbuphine, a mixed agonist-antagonist opioid, has a potential to attenuate the mu-opioid effects and to enhance the kappa-opioid effects. However, when morphine and nalbuphine are mixed together, the clinical interactions in different combining ratios on analgesic effect and adverse events are unknown. ⋯ The interaction between morphine and nalbuphine in PCA admixture on analgesia is additive. Combinations of morphine and nalbuphine in PCA can decrease the incidence of pruritus, and the antipruritus effect is ratio-dependent. This may provide a novel combination strategy of opioid agonist and agonist-antagonist for postoperative pain management after gynaecologic surgery.
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Randomized Controlled Trial
Evaluation of intra-operative tramadol for prevention of catheter-related bladder discomfort: a prospective, randomized, double-blind study.
Catheter-related bladder discomfort (CRBD) is defined as an urge to void or discomfort in the supra-pubic region; reported postoperatively in patients who have had urinary catheterization intra-operatively. We have evaluated tramadol, a centrally acting opioid analgesic with muscarinic receptor antagonist properties for prevention of CRBD. ⋯ Tramadol 1.5 mg kg(-1) administered i.v. 30 min before extubation decreases the incidence and severity of CRBD and postoperative fentanyl requirement.
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Randomized Controlled Trial
GlideScope video laryngoscope: a randomized clinical trial in 203 paediatric patients.
The GlideScope intubating device has been reported to provide a comparable or superior laryngoscopic view compared with direct laryngoscopy in adults. This study compared the use of the GlideScope with direct laryngoscopy for the laryngoscopic view and intubation time in children. ⋯ In children, the GlideScope provided a laryngoscopic view equal to or better than that of direct laryngoscopy but required a longer time for intubation.
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Pharmacokinetics of an i.v. prodrug of acetaminophen (propacetamol) in neonates after repeat dosing are reported, with scant data for i.v. acetaminophen formulation. ⋯ The parameter estimates are similar to those described for propacetamol. There was no evidence of hepatotoxicity. Unconjugated hyperbilirubinaemia impacts upon CL, dictating dose reduction.
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Hip fractures are common in the elderly and have a high 30 day postoperative mortality. The ability to recognize patients at high risk of poor outcomes before operation would be an important clinical advance. This study has determined key prognostic factors predicting 30 day mortality in a hip fracture population, and incorporated them into a scoring system to be used on admission. ⋯ We have developed and validated a scoring system that reliably predicts the probability of mortality at 30 days for patients after hip fracture.