British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Nitrous oxide and day-case laparoscopy: effects on nausea, vomiting and return to normal activity.
Patients admitted for day-case laparoscopy were assigned randomly to receive nitrous oxide-oxygen or oxygen, with enflurane, during a standard anaesthetic technique. Postoperative morbidity, in particular nausea and vomiting, and ability to resume normal activity were assessed over the ensuing 48 h. Supplementary administration of propofol during the operative procedure was required significantly more often (P less than 0.05) in the absence of nitrous oxide. ⋯ The incidence and severity of nausea over the 48 h following operation was similar in both groups. There was no difference in analgesic or anti-emetic requirements before discharge and the time taken to resume normal activity was similar. It is concluded that nitrous oxide may be avoided readily in day-case laparoscopy without affecting postoperative morbidity or time taken to return to "street fitness" and normal activity.
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Randomized Controlled Trial Comparative Study Clinical Trial
Controlled comparison of a new sublingual lormetazepam formulation and i.v. diazepam in outpatient minor oral surgery.
In a randomized, double-blind, parallel groups study, 40 patients undergoing surgical removal of impacted 3rd molar teeth received either sublingual lormetazepam 2.5 mg (n = 20) in a new cellulose wafer formulation followed at 35 min by i.v. saline; or sublingual placebo followed at 35 min by i.v. diazepam 10 mg (Diazemuls). Rapid onset of sedation was seen after sublingual lormetazepam, while the course and duration of postoperative sedation, measured using standard psychometric tests, was similar following both treatments. ⋯ Both treatments were tolerated well, with no significant cardiovascular complications. These results indicate that sublingual lormetazepam may have a role in anaesthesia as a premedicant and for conscious sedation.
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Neuromuscular blockade was obtained with vecuronium 108 micrograms kg-1 in 44 patients undergoing diagnostic muscle biopsy as part of an investigation of malignant hyperthermia (MH) susceptibility. At the termination of anaesthesia doxapram 1.43 mg kg-1 was given in an attempt to antagonize postoperative respiratory depression. Rectal, muscle and skin temperatures, blood lactate concentration and venous PCO2 were measured before, during and after anaesthesia. ⋯ There were no differences between the three groups in rectal or muscle temperature, blood lactate concentration or venous PCO2 at any time. Doxapram did not prevent an increase in postoperative PCO2. It is concluded that vecuronium and doxapram may be safely administered to patients susceptible to MH.
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Randomized Controlled Trial Clinical Trial
Modification by alfentanil of the haemodynamic response to tracheal intubation in elderly patients. A dose-response study.
Fifty-five elderly patients undergoing elective ophthalmological surgery were randomly allocated to four groups. Following the induction of anaesthesia with thiopentone (given over 2 min) and the administration of atracurium 0.6 mg kg-1, patients received alfentanil 400, 600, 800 or 1000 micrograms. Intubation of the trachea was performed 90 s later. ⋯ In each of the groups there was a significant decrease in systolic arterial pressure and a significant increase in heart rate on induction of anaesthesia. In those patients who received either 400 or 600 micrograms of alfentanil, arterial pressure increased immediately after tracheal intubation, whereas in those receiving alfentanil 800 or 1000 micrograms, arterial pressure decreased immediately after tracheal intubation, and when measured 10 min after intubation. It is suggested that alfentanil 600 micrograms (10 micrograms kg-1) constitutes the optimal dose with which to obtund the haemodynamic response to tracheal intubation in elderly patients, and to minimize cardiovascular depression after tracheal intubation.