British journal of anaesthesia
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Single-dose i.v. granisetron in the prevention of postoperative nausea and vomiting.
In this randomized, double-blind, parallel group, placebo-controlled, dose-ranging study, we have compared three doses (0.1 mg, 1.0 mg and 3.0 mg) of the 5-HT3 receptor antagonist, granisetron (Kytril), as prophylactic therapy for the prevention of postoperative nausea and vomiting. The aims were to determine the optimal dose of granisetron and to evaluate its safety profile. We studied 527 adult patients, undergoing elective open abdominal surgery or vaginal hysterectomy during general anaesthesia. ⋯ The two higher doses of granisetron (1.0 mg and 3.0 mg) provided effective prophylaxis against vomiting, with 78% and 77% of patients, respectively, being free from vomiting in the first 6 h after surgery, and 63% and 62% in the first 24 h. This compares with 50% and 34% at 0-6 h and 0-24 h, respectively, in the placebo group. Granisetron was well tolerated and the optimum dose was 1.0 mg.
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Randomized Controlled Trial Comparative Study Clinical Trial
Dose requirements, efficacy and side effects of morphine and pethidine delivered by patient-controlled analgesia after gynaecological surgery.
We have compared the dose requirements and side effects of morphine with those of pethidine when administered by patient-controlled analgesia in 40 patients (ASA I-II, 20-65 yr) after elective total abdominal hysterectomy. Patients were allocated randomly, in a double-blind manner, to receive either morphine (bolus dose 2 mg, lockout time 10 min) or pethidine (bolus dose 20 mg, lockout time 10 min) for postoperative pain relief. ⋯ Four patients receiving pethidine were withdrawn because of postoperative confusion and one receiving morphine because of intractable nausea and vomiting. The 95% confidence interval for this difference between the groups for VAS scores of sedation, nausea and pain were approximately 30 mm.
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Randomized Controlled Trial Clinical Trial
Magnesium sulphate enhances residual neuromuscular block induced by vecuronium.
Magnesium sulphate (MgSO4) is currently used for haemodynamic control during anaesthesia and the early postoperative period. We have investigated the effect of this treatment on residual neuromuscular block after administration of vecuronium. ⋯ MgSO4 caused rapid and profound recurarization in all 20 patients. MgSO4 decreased the amount of acetylcholine released at the motor nerve terminal and thus may lead to recurarization in patients previously exposed to neuromuscular blocking agents.
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Randomized Controlled Trial Clinical Trial
Effect of apparatus on functional residual capacity.
As the route of breathing and use of airway apparatus such as mask, mouthpiece and noseclip can alter breathing pattern, this study has used the helium dilution method to estimate the effects of mouthpiece and mask breathing on functional residual capacity (FRC) in the supine position, and the change in FRC that occurs between the sitting and supine positions while breathing by mouthpiece. In 13 normal subjects, breathing by mouthpiece, FRC was smaller, by a median of 1.07 litre (interquartile values 0.73-1.43 litre) in the supine compared with the sitting position (P < 0.01), but residual volume (RV) did not change significantly. FRC measured in the supine position was significantly greater when breathing by mask than by mouthpiece (0.25, 0.04-0.38 litre) and RV was greater by similar amounts (0.20, -0.02 to 0.49 litre). This difference may result from increased inspiratory activity while breathing via the mask.
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Randomized Controlled Trial Comparative Study Clinical Trial
Convective warming combined with vasodilator therapy accelerates core rewarming after coronary artery bypass surgery.
In a prospective, randomized, controlled study, we have investigated the effect of forced air warming on the rate of change of nasopharyngeal and rectal temperatures in 20 patients after coronary artery bypass grafting. All patients had nasopharyngeal temperatures less than 36 degrees C on arrival in the intensive care unit and received an infusion of glyceryl trinitrate 15 mg h-1, but none received inotropes. ⋯ The rates of increase in nasopharyngeal temperature were 0.4 and 0.95 degrees C h-1, respectively, in the control and Bair Hugger groups (P < 0.01) during the first 2 h after operation. Over the same period of time, rectal temperatures increased at a rate of 0.25 and 0.75 degrees C h-1 in the control and Bair Hugger groups, respectively (P < 0.01).