British journal of anaesthesia
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The influence of renal failure on the disposition of morphine and its metabolites was studied in nine patients with end-stage renal failure undergoing transplantation, and compared with five healthy anaesthetized patients. All patients received morphine sulphate pentahydrate 10 mg i.v. over 30 s, as part of a balanced anaesthetic technique. Venous blood samples were collected for up to 24 h, and plasma concentrations of morphine, morphine-3-glucuronide (M3G), and morphine-6-glucuronide (M6G) assayed by a differential radioimmunoassay method. ⋯ However, the volume of distribution at steady state was greater in the control group (241 litre v. 141 litre; P = 0.002). The peak concentrations of M3G and M6G were greater in the renal transplant patients (P = 0.001 and P = 0.01, respectively), as were the AUC (0-24 h) (P = 0.002 and P = 0.002). M6G has been shown to possess analgesic properties in both man and experimental animals, and therefore the increased AUC for M6G may contribute to the prolonged effect seen with morphine when given to patients with impaired renal function.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of propofol and thiamylal for induction and maintenance of anaesthesia for outpatient surgery.
In an open, randomized study we have compared the safety and efficacy of propofol with thiamylal for induction and maintenance of anaesthesia supplemented by nitrous oxide in elective termination of pregnancy. Induction of anaesthesia was achieved with either propofol 2.5 mg kg-1 or thiamylal 4.0 mg kg-1 followed by maintenance with 70% nitrous oxide in oxygen and repeat boluses of 25% of the induction dose i.v. as indicated clinically. ⋯ The patients in the propofol group were alert and orientated early in the postoperative period, with less nausea or vomiting. Propofol has properties that are of particular benefit in anaesthesia for ambulatory surgery.
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Randomized Controlled Trial Comparative Study Clinical Trial
Pipecuronium and pancuronium: comparison of pharmacokinetics and duration of action.
The pharmacokinetics of pipecuronium 0.07 mg kg-1 and pancuronium 0.1 mg kg-1 were compared in 39 ASA class I or II patients. Plasma concentrations of these agents were measured for 6 h following administration, using a sensitive and specific capillary gas chromatographic assay. Concentration v. time data were analysed by non-linear regression and fitted to a two- or three-compartment model as appropriate. ⋯ The volumes of the central compartment, distribution and elimination half-lives and mean residence times were similar for both agents and within the range expected for drugs of this type. The durations of action (injection to 25% recovery of twitch tension) of pipecuronium and pancuronium were similar: 98.0 (36.1) min and 117.2 (35.8) min, respectively. We conclude that the time courses of neuromuscular blockade following pipecuronium and pancuronium are similar, despite the differences in Vss and Cl.
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Randomized Controlled Trial Clinical Trial
Ilioinguinal nerve blockade for analgesia after caesarean section.
Bilateral ilioinguinal nerve blockade was performed, using 0.5% plain bupivacaine 10 ml to each side, in 13 patients having elective Caesarean section under general anaesthesia. Pain scores and requirement for postoperative analgesia were compared with 13 patients in a control group. ⋯ In the control group, patients required more analgesia in the first 24 h after surgery compared with patients having ilioinguinal nerve blockade. There were no observed adverse effects following nerve blocks.
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Stained, quick setting resin was injected into the thoracic paravertebral spaces of six cadavers to assess the suitability of this material for delineating the spread of injected substances in an area of the human body which is being re-evaluated currently as a repository for analgesic drugs. The distribution and spread of the resin in relation to intercostal spaces, vertebral bodies and the spinal cord were noted, and compared with other studies.