British journal of anaesthesia
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Randomized Controlled Trial Multicenter Study Clinical Trial
Continuous extradural infusion of ropivacaine for prevention of postoperative pain after major orthopaedic surgery.
We studied 151 patients undergoing total hip or knee arthroplasty, or cruciate ligament reconstruction in a multicentre study in Australia and New Zealand. Patients were openly allocated randomly to one of five treatment groups or to a control group. General anaesthesia was induced after introduction of extradural block with 0.5% ropivacaine. ⋯ The quality of treatment scores were similar for all treatment groups (Br. J. Anaesth. 1996; 76: 606-610).
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Randomized Controlled Trial Multicenter Study Clinical Trial
A new tracheal tube for difficult intubation.
We have compared a new Portex tracheal tube with the Oxford tube in performing simulated grade 3 difficult intubations. The Portex tube was modified so that the bevel faced backwards, as in the Oxford tube. A gum elastic introducer was used with both tubes. ⋯ Over the course of the study, intubation time decreased progressively (P < 0.001). This provides new evidence of the need for trainees to practise the art of intubation when the cords are not visible. Our estimate of the learning "half-life" was 15 intubations; we conclude that 30 simulated grade 3 intubations would be a reasonable objective for trainees before handling high-risk cases.
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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 Multicenter Study Comparative Study Clinical Trial
Single dose i.v. tropisetron in the prevention of postoperative nausea and vomiting after gynaecological surgery.
In a prospective, randomized, multicentre, double-blind, placebo-controlled study, we have compared the efficacy of a single i.v. dose of tropisetron 0.5 mg, 2 mg and 5 mg in the prevention of postoperative nausea and vomiting (PONV). We studied 385 ASA class I and II female patients undergoing abdominal or vaginal gynaecological surgery, including laparoscopy. ⋯ Compared with placebo, nausea was reduced from 55% to 46%, 34% and 46% (P = 0.25, P = 0.003, P = 0.22), and need for rescue treatment from 39% to 29%, 23% and 35% (P = 0.13, P = 0.017 and P = 0.59) for the same groups. Tropisetron 2 mg appeared to be the optimal dose for prophylaxis against PONV with a side-effect profile similar to that of placebo.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Extradural ropivacaine and bupivacaine in hip surgery.
We studied 126 patients undergoing elective hip surgery; they received 20 ml of 0.5%, 0.75%, 1.0% ropivacaine or 0.5% bupivacaine extradurally in a double-blind design. Sensory block (pinprick), motor block (modified Bromage scale), quality of analgesia and neuromuscular block were assessed intermittently. Heart rate and arterial pressure were measured at regular intervals. ⋯ Duration and quality of analgesia and motor block increased with the concentration of ropivacaine. Ropivacaine 1.0% provided a longer duration of analgesia and motor block, more intense motor block and more patients with satisfactory analgesia than 0.5% bupivacaine. More patients treated with the higher concentrations of ropivacaine required treatment for hypotension and bradycardia.