British journal of anaesthesia
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Alfentanil was administered, together with midazolam, as part of a total i.v. anaesthetic technique. The pharmacokinetics of alfentanil were determined in 10 female patients undergoing lower abdominal surgery. The dose regimen of alfentanil, based on simulation studies, consisted of a two-stage infusion following an initial bolus dose. ⋯ Neither lower abdominal surgery nor the simultaneous administration of midazolam seemed to affect the kinetics of alfentanil as compared with results from studies in healthy volunteers. The short half-life of alfentanil, resulting from a small volume of distribution, makes it suitable as part of a total i.v. technique. Consideration must be paid, however, to interindividual differences in the pharmacodynamic response and in plasma clearance.
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Randomized Controlled Trial Comparative Study Clinical Trial
Postoperative analgesia by continuous extradural infusion of bupivacaine and diamorphine.
Three solutions administered by continuous extradural infusion for postoperative analgesia were compared in a randomized, double-blind manner. All patients underwent major abdominal gynaecological surgery and received 0.125% bupivacaine in 0.9% saline, diamorphine in 0.9% saline (0.5 mg in 15 ml) or diamorphine mixed with 0.125% bupivacaine (0.5 mg in 15 ml), at a rate of 15 ml h-1. The bupivacaine-diamorphine mixture provided significantly superior analgesia compared with either bupivacaine or diamorphine alone. No major side effects were encountered.
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Comparative Study
Decontamination of halothane from anaesthetic machines achieved by continuous flushing with oxygen.
The contamination of four types of anaesthetic machine with halothane was sequentially sampled by mass spectrometry while the machines were continuously flushed with oxygen 8 litre min-1 for up to 24 h. Contamination decreased in an exponential manner. Machines fitted with Selectatec vaporizer mounting systems and with the vaporizer removed showed contamination less than 0.02 parts per million (p.p.m.) of halothane after 12 h flushing. ⋯ Background contamination concentrations of greater than 0.05 p.p.m. were measured in a patient-free recovery area of an operating theatre suite. Concentrations increased to 1 p.p.m. when patients were admitted following halothane anaesthesia. Decontamination of anaesthetic machines to concentrations of halothane below those detected as background contamination within recovery areas may allow such machines to be used safely to anaesthetize patients at risk from halothane.
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Randomized Controlled Trial Comparative Study Clinical Trial
Intrathecal morphine in the management of pain following cardiac surgery. A comparison with morphine i.v.
Forty-four patients undergoing coronary revascularization received either intrathecal morphine 1 mg (n = 15), intrathecal morphine 2 mg (n = 15), or i.v. morphine 30 mg (n = 14) after the induction of anaesthesia. Morphine 2.5 mg i.v. was given, as required, in the postoperative period and pain score, respiratory rate and PaCO2 measured every 2 h. FVC, FEV1 and PEFR were measured before, and 24 h after, the induction of anaesthesia. ⋯ Postoperative PEFR was significantly better in patients given intrathecal morphine (P less than 0.01). These results suggest that intrathecal morphine provided better analgesia after cardiac surgery than did a conventional regimen. The lower dose (1 mg) was associated with less respiratory depression as assessed by PaCO2 measurements.