British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Nausea and vomiting after cardiac surgery.
We have undertaken a prospective, randomized study to determine the incidence of postoperative nausea and vomiting during intensive care stay after cardiac surgery, and to study the effect of addition of droperidol to an infusion of morphine used for postoperative analgesia. Data from 398 patients were examined. ⋯ Mean duration of intubation was 4.9 h and was unaffected by the use of droperidol. Droperidol had no effect on mean length of stay in the recovery unit.
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We studied 10 patients during the first night after upper abdominal surgery to assess the effect of airway obstruction on chest wall mechanics, by recording nasal gas flow and carbon dioxide concentration, rib cage and abdominal dimensions, abdominal muscle activity, and oesophageal and gastric pressures. The mean duration of study of each subject was 5.8 h, and 5.2 h were analysed. The median proportion of time spent breathing with normal mechanics was 29% (interquartile values 0-57%). ⋯ This occurred for 34 (0-52)% of the time. Both patterns were associated with evidence of increased activation of the abdominal muscles during expiration, changing the relationship of abdominal and pleural pressure changes and chest wall movements. Such changes have been interpreted previously as evidence of diaphragm dysfunction.
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Randomized Controlled Trial Comparative Study Clinical Trial
Influence of induction technique on intubating conditions after rocuronium in adults: comparison with rapid-sequence induction using thiopentone and suxamethonium.
We have assessed the effect of anaesthetic technique on intubating conditions after rocuronium 0.6 mg kg-1 in four groups (n = 25 each) of unpremedicated patients in whom anaesthesia was induced with either thiopentone 5 mg kg-1 or propofol 2.5 mg kg-1 alone, or supplemented with alfentanil 20 micrograms kg-1. Fifty control patients were anaesthetized with thiopentone followed by suxamethonium. Laryngoscopy was commenced at 45 s. ⋯ However, intubation time was similar in all five groups and averaged 55 (SD 3.2) s, and the tube could be passed through open vocal cords within 70 s. After rocuronium the response of the diaphragm to intubation was more pronounced in the two groups of patients not receiving alfentanil (P < 0.0001) and in patients anaesthetized using propofol with alfentanil (P < 0.01) than in the control group. Opioids (in doses equivalent to alfentanil 20 micrograms kg-1) constitute an integral part of an induction regimen containing rocuronium 0.6 mg kg-1, regardless of whether or not thiopentone or propofol is used, in order to achieve overall intubating conditions similar to those after suxamethonium.
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Comparative Study Clinical Trial Controlled Clinical Trial
Thoracic impedance used for measuring chest wall movement in postoperative patients.
Thoracic impedance (TTI) and rib cage inductance band (IB) signals were measured in 10 patients during the first night after abdominal surgery, and compared by successive correlation of the change in each signal. Poor matching of the signals occurred, on average, for 94 min either because of movement of differences in the waveform. There were frequent episodes of transient poor correlation, generally associated with transient respiratory disturbance, predominantly airway obstruction (58%). Thoracic impedance measurements are simpler than inductance band methods for detecting rib cage movement and may be useful for large studies of respiratory abnormalities in patients after operation.