British journal of anaesthesia
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Clinical Trial Controlled Clinical Trial
Pulmonary function and pain after gastroplasty performed via laparotomy or laparoscopy in morbidly obese patients.
We have compared severely obese patients (body mass index > 35 kg m-2) undergoing laparoscopic or open gastroplasty (n = 15 in each group) to determine if laparoscopy results in any benefit in the obese. Postoperative pain, measured on a 100-mm visual analogue scale, and opioid consumption were recorded during the first two days after operation. Tests of pulmonary function were performed and SpO2 was measured 4 h after surgery and on days 1, 2 and 3 after operation. ⋯ Forced vital capacity, forced expiratory volume in 1 s and peak expiratory flow rate were reduced significantly less after laparoscopic gastroplasty than after open gastroplasty (on day 1 forced vital capacity was reduced by 50% compared with 64%, forced expiratory volume in 1 s was reduced by 50% compared with 66% and peak expiratory flow rate by 45% compared with 60%). SpO2 values were significantly greater in the laparoscopy group (day 1: mean 95 (SD 2)% vs 91 (5)%; day 3: 97 (1)% vs 94 (3)%). This study suggests that the beneficial effects observed after laparoscopic gastroplasty in morbidly obese patients were similar to those reported after laparoscopic cholecystectomy in non-obese patients.
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Randomized Controlled Trial Comparative Study Clinical Trial
Augmentation of the neuromuscular blocking effects of cisatracurium during desflurane, sevoflurane, isoflurane or total i.v. anaesthesia.
We have evaluated the enhancement of cisatracurium-induced neuromuscular block by potent inhalation anaesthetic agents, by constructing dose-effect curves for cisatracurium in 84 patients during anaesthesia with 1.5 MAC (70% nitrous oxide) desflurane, sevoflurane, isoflurane or total i.v. anaesthesia (TIVA). Acceleromyography (TOF-Guard) and train-of-four (TOF) stimulation of the ulnar nerve were used (2 Hz every 12 s). Cisatracurium was administered in increments of 15 micrograms kg-1 until depression of T1/T0 > 95% was reached. ⋯ These were significantly lower than the values for TIVA (21 (4) and 51 (13) micrograms kg-1) (P < 0.01 in each case). After equi-effective dosing, times to T1/T0 = 25% were similar in all groups (19 (7), 19 (5), 20 (5) vs 16 (4) min). Recovery index25-75% and time to a TOF ration of 0.70 were prolonged significantly by desflurane and sevoflurane compared with TIVA (18 (5), 19 (8) vs 12 (4) min and 43 (11), 44 (10) vs 35 (5) min, respectively), whereas the difference was not significant for isoflurane (14 (6) and 41 (7) min).
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Comparative Study Clinical Trial Controlled Clinical Trial
Bispectral index: comparison of two montages.
We have compared fronto-central and bifrontal montages using a new EEG monitor, the Aspect A-1000. The monitor uses bispectral analysis to derive an index of anaesthetic depth, the bispectral index (BIS). We compared reliability, impedance and BIS for each montage. ⋯ However, BIS values derived from each montage were found to differ in an unpredictable manner. The bifrontal montage is easy to apply and reliable but it is not comparable with a fronto-central montage. We conclude that the BIS may be useful for following trends in anaesthetic depth in individual cases but it is less helpful when making comparison between patients or as a single value.
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Infusion of propofol by a target-controlled infusion (TCI) system is effective in achieving conscious sedation for anxious patients presenting for dental surgery. It is a common clinical observation that anxious patients require more anaesthetic drugs than non-anxious individuals. In study 1 we have defined blood propofol concentrations necessary for conscious sedation in both anxious (n = 23) and non-anxious (n = 18) patients. ⋯ In study 2, an optimized set of microconstants was derived which should more accurately predict the pharmacokinetic profile of the anxious population and this set was tested prospectively in another group of 12 anxious dental patients. Bias and precision with the optimized kinetic set were significantly less than the values obtained in study 1. We conclude that there was no significant pharmacokinetic differences between anxious and non-anxious subjects receiving subanaesthetic doses of propofol for conscious sedation.
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Comment Letter Case Reports
Sevoflurane for difficult intubation in children.