British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Spontaneous movements associated with rocuronium: is pain on injection the cause?
Spontaneous movements are sometimes observed of the arm into which rocuronium is administered. In order to assess a possible relationship between these movements and pain, we injected in 10 awake, ASA I patients, in a double-blind manner, both rocuronium 1 ml (10 mg) and 0.9% NaCI 1 ml (placebo), with a 30-s interval in between. ⋯ A second injection of rocuronium did not produce such pain and no movements were observed. We conclude that injection of rocuronium is associated with severe, burning pain of short duration, responsible for the spontaneous movements in the arm observed after induction of anaesthesia.
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Clinical Trial
Metabolic, biochemical and haemodynamic effects of infusion of propofol for long-term sedation of children undergoing intensive care.
We have studied prospectively, in nine children requiring sedation to facilitate mechanical ventilation, the metabolic, biochemical and haemodynamic effects of infusion of propofol. Children were given infusions of propofol 1-4mg kg-1 h-1 and fentanyl 1-5 micrograms kg-1 h-1 for 48 h. Heart rate, arterial pressure, central venous pressure, fluid balance and urine output were recorded hourly and sedation scores every 4 h. ⋯ Under these very proscriptive conditions we did not encounter lipaemia or acidosis with infusion of propofol. Thus propofol may be a safe sedative agent for use in paediatric intensive care if used appropriately. Further large scale studies are needed to determine if warnings against the use of this agent in paediatric intensive care units are justified.
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We have studied the train-of-four (TOF) response mechanomyographically during onset of neuromuscular block produced by subclinical doses of suxamethonium in order to follow the augmentation of the first twitch of the TOF (T1) and TOF fade compared with control TOF responses before the drug was given. In the groups given suxamethonium 0.05, 0.1, 0.2 and 0.3 mg kg-1, the increments in T1 after administration of the drug were observed before twitch depression occurred; these were mean 22.3 (SEM 8.1)%, 19.2 (3.3)%, 10.8 (2.0)% and 4.2 (2.2)%, respectively. ⋯ The results of this study suggest that low doses of suxamethonium produced transient increase in muscle tension and twitch depression with significant TOF fade. We conclude that suxamethonium was associated with presynaptic effects as a consequence of brief stimulation of acetylcholine release followed by progressive diminution at the neuromuscular junction.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Ondansetron compared with metoclopramide in the treatment of established postoperative nausea and vomiting. The French Ondansetron Study Group.
We have studied 746 males and females undergoing general anaesthesia for any type of surgical procedure in a double-blind, controlled, randomized study. After experiencing at least one nausea and/or one emetic episode in the 6 h after recovery from anaesthesia, patients received either ondansetron 4 mg i.v. or metoclopramide 10 mg i.v. Patients were observed for postoperative nausea and vomiting (PONV) for 24 h after drug administration. ⋯ Furthermore, ondansetron was associated with greater patient satisfaction than metoclopramide (P < 0.001) with 49% and 32% of patients, respectively, very satisfied. The overall incidence of adverse events was similar in the ondansetron (7%) and metoclopramide (8%) groups. Ondansetron was as well tolerated and more effective than metoclopramide for all assessment criteria in the treatment of established PONV.