British journal of anaesthesia
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We have studied dose requirements, recovery times and pharmacokinetics of rocuronium in 32 intensive care patients. After an initial dose of 50 mg, rocuronium was administered as maintenance doses of 25 mg whenever two responses to train-of-four (TOF) stimulation reappeared (bolus group; n = 27) or by continuous infusion to maintain one response in the TOF (infusion group; n = 5). Median requirements for rocuronium were 27.4 (range 14.5-68.3) mg h-1 and 43.7 (30.9-50.3) mg h-1 in patients in the bolus and infusion groups, respectively. ⋯ The plasma concentration profile (n = 12) was described adequately by a two-compartment model. Mean plasma clearance (Cl), steady-state distribution volume (Vss), mean residence time (MRT) and elimination half-life (T1/2 beta) were 3.16 (SD 1.15) ml kg-1 min-1, 769 (334) ml kg-1, 262 (120) min and 337 (163) min, respectively. Recovery times, Vss, MRT, and T1/2 beta differed from previously published data obtained after rocuronium infusion of moderate duration in surgical patients.
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Meta Analysis
Propofol anaesthesia and postoperative nausea and vomiting: quantitative systematic review of randomized controlled studies.
We have analysed randomized controlled studies which reported the incidence of postoperative nausea and vomiting (PONV) after propofol anaesthesia compared with other anaesthetics (control). Cumulative data of early (0-6 h) and late (0-48 h) PONV were recorded as occurrence or non-occurrence of nausea or vomiting. Combined odds ratio and number-needed-to-treat were calculated for propofol as an induction or maintenance regimen, early or late outcomes, and different emetic events. ⋯ This may be clinically relevant. In all other situations the difference between propofol and control may have reached statistical significance but was of doubtful clinical relevance. Treatment efficacy should be established within a defined range of control event rates for meaningful estimates of efficacy and for comparisons.
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Meta Analysis Comparative Study
Meta-analytic comparison of prophylactic antiemetic efficacy for postoperative nausea and vomiting: propofol anaesthesia vs omitting nitrous oxide vs total i.v. anaesthesia with propofol.
Data from two published and one new meta-analysis were reviewed to compare the antiemetic efficacy of three different anaesthetic regimens: (i) propofol anaesthesia compared with another anaesthetic (control); (ii) anaesthesia without nitrous oxide compared with the same anaesthetic with nitrous oxide (control); (iii) propofol anaesthesia without nitrous oxide (TIVA) compared with another anaesthetic with nitrous oxide (control). Efficacy (prevention of postoperative nausea and vomiting compared with control) was estimated using odds ratio and number-needed-to-treat methods, and compared within a range of 20-60% control event rates for early efficacy (0-6 h) and 40-80% for late efficacy (0-48 h). Propofol anaesthesia or omitting nitrous oxide had similar effects on vomiting, both early and late. ⋯ TIVA studies were documented poorly; appropriate comparison with other interventions were not possible. Efficacy of treatments should be compared within a setting-specific range of control event rates. There is insufficient evidence that TIVA with propofol is an anaesthetic technique with a low emetogenic potency.
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Randomized Controlled Trial Comparative Study Clinical Trial
Effect of percutaneous local anaesthetics on pain reduction during pulse dye laser treatment of portwine stains.
We have used EMLA, 4% amethocaine gel and placebo for facial portwine stains, for a period of 1 h, in a double-blind study. After removal of the preparations from the skin surface, each area was treated with six pulses of the laser, each 5 mm in diameter. ⋯ Twenty nine patients completed the study and statistical analysis of the results indicated that both EMLA and 4% amethocaine gel were superior to placebo (P < 0.001). However, when EMLA and 4% amethocaine gel were compared, the amethocaine preparation was significantly better (P < 0.05, VAS; P < 0.005 VRS) than EMLA in reducing pain caused by the laser treatment.
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Randomized Controlled Trial Clinical Trial
Does intrathecal fentanyl produce acute cross-tolerance to i.v. morphine?
We have examined the hypothesis that intrathecal fentanyl at operation can increase postoperative i.v. morphine requirements. We studied 60 patients undergoing Caesarean section. All received intrathecal 0.5% plain bupivacaine 2 ml combined with either fentanyl 0.5 ml (25 micrograms) (group F) (n = 30) or normal saline 0.5 ml (group S) (n = 30). ⋯ Up to 6 h after delivery there was no difference in postoperative morphine requirements or pain scores. Between 6 h and 23 h there was a 63% increase in morphine requirements in group F. We consider the most likely explanation for this finding to be that intrathecal fentanyl induced acute spinal opioid tolerance.