British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of chloral hydrate and midazolam by mouth as premedicants in children undergoing otolaryngological surgery.
Chloral hydrate 25, 50 or 75 mg kg-1 or midazolam 0.4, 0.5 or 0.6 mg kg-1, all given by mouth in combination with atropine 0.03 mg kg-1, were compared as premedication in 248 children in a randomized, double-blind study. Chloral hydrate was significantly less palatable than midazolam. The anxiolytic effect of chloral hydrate 75 mg kg-1 was "good" in children younger than 5 yr, whereas the other doses of chloral hydrate, and all doses of midazolam, provided only "fair" anxiolysis in this age group. ⋯ The mean total recovery score (0-10) based on activity, ventilation, heart rate, conscious level and colour ranged between 5.8 and 6.8 at 10 min and between 9 and 9.5 at 70 min after extubation in all groups. Midazolam 0.5 mg kg-1 is recommended for children less than 5 yr of age and midazolam 0.4-0.5 mg kg-1 for older ones. Chloral hydrate 75 mg kg-1 provided good anxiolysis in both age groups; however, it was less palatable than the midazolam.
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Randomized Controlled Trial Clinical Trial
Influence of neostigmine on postoperative vomiting.
Thirty-eight patients undergoing elective hip or knee surgery were randomly allocated to two groups. Neuromuscular blockade in group A was antagonized with neostigmine 2.5 mg and atropine 1.2 mg, while group B received no drugs to facilitate antagonism of blockade. The incidence and severity of postoperative nausea and vomiting were assessed 24 h after operation. ⋯ The incidence of nausea in group A was 68%, compared with 32% in group B (P less than 0.01). The incidence of vomiting was 47% in group A, compared with 11% in group B (P less than 0.02). A significant relationship was shown between postoperative emetic symptoms and the antagonism of neuromuscular blockade by neostigmine and atropine.
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Randomized Controlled Trial Comparative Study Clinical Trial
Spinal anaesthesia with 0.5% bupivacaine 3 ml: comparison of plain and hyperbaric solutions administered to seated patients.
In a double-blind study, 0.5% bupivacaine 3 ml in plain (n = 10) or hyperbaric (n = 10) solution was injected intrathecally to 20 patients who were in the sitting position, to produce spinal anaesthesia for transurethral resection of prostate. No statistically significant differences were found in time to maximum cephalad spread of analgesia nor in the level reached. ⋯ There was no difference in the incidence of complete motor block, but a longer duration of lesser degrees of motor block was found with the plain solution (P less than 0.05). The plain solution produced a more predictable level of blockade.
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Twenty-two anaesthetists participated in a study to assess the influence of occupational exposure to anaesthetic agents on mood (arousal and stress) and cognitive functions. In a cross-over design, each anaesthetist worked one day in a reference facility (for example, intensive care) and another day in a scavenged operating theatre where time-weighted exposure averaged nitrous oxide 58 p.p.m. and halothane 1.4 p.p.m. The results showed that arousal scores reached a peak in the middle of the theatre day, but this appeared to reflect the nature of operating theatre work rather than exposure. ⋯ Similarly, there was no evidence that exposure impaired performance of tasks assessing syntactic and semantic reasoning, verbal and spatial memory, sensory-motor reaction time and attention. Performance in these tasks was, however, sensitive to the cognitive demands of the tasks and to naturally varying non-exposure factors. It is concluded that, compared with the reference condition, the concentrations of anaesthetic agents found in actively scavenged operating theatres have no detrimental effect on either the mood or the cognitive functions of anaesthetists.