Journal of the Medical Association of Thailand = Chotmaihet thangphaet
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Randomized Controlled Trial Comparative Study Clinical Trial
Effectiveness of intravenous meperidine for pain relief in the first stage of labour.
To determine the effectiveness and side effects of intravenous meperidine in labour pain relief. ⋯ Intravenous meperidine exhibited the effectiveness of pain relief of only 23.80 per cent of the subjects, in addition, it may cause many side effects.
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Randomized Controlled Trial Comparative Study Clinical Trial
Oral ibuprofen and indomethacin for treatment of patent ductus arteriosus in premature infants: a randomized trial at Ramathibodi Hospital.
Ibuprofen given intravenously to premature newborn infants is a proven treatment for patent ductus arteriosus (PDA). The efficacy of ibuprofen is comparable to indomethacin in many clinical trials with fewer renal side effects. However, the intravenous form of ibuprofen is not available in Thailand, whereas, the oral suspension form is widely used for antipyretic treatment in children. Therefore, the authors investigated the possibilities of using oral ibuprofen for the treatment of PDA in premature newborn infants. ⋯ Oral ibuprofen therapy is as effective as indomethacin for the treatment of PDA in premature infants and seems to have fewer renal side effects.
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Randomized Controlled Trial Comparative Study Clinical Trial
Dead space ventilation in volume controlled versus pressure controlled mode of mechanical ventilation.
Dead space ventilation (VD) is one of the important measurements that indicates the ventilatory efficiency of a patient who requires mechanical ventilation. However, VD is not constant and can change according to the pathology in the lungs, ventilatory patterns, perfusion and ventilation-perfusion matching. The objective of this study was to measure and compare the dead space in pediatric patients who were using pressure controlled and volume controlled modes of mechanical ventilatory by measuring the difference between arterial PCO2 and end-tidal PCO2 [P(a-ET)CO2]. ⋯ The P(a-ET)CO2 between volume controlled and pressure controlled mode were 3.1 and 2.6 torr (p = 0.5) and peak inspiratory pressure were 20.0 and 17.3 torr (p = 0.01), respectively; whereas mean airway pressure, PaO2, O2 saturation and heart rate revealed no significant difference between these two modes. The authors concluded that VD in pressure controlled mode from the present study was not significantly different from VD when using volume controlled mode of mechanical ventilation in the same patient. However, VD will change according to the pathophysiologic change in respiratory system and can be used for monitoring of ventilatory pattern of patients in the pediatric intensive care unit.
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Randomized Controlled Trial Clinical Trial
Starting intravenous morphine in the postanesthesia care unit yielded better postoperative analgesia.
The administration of morphine intravenously in the Postanesthesia Care Unit (PACU) was practiced in many parts of the world, but not routinely done in Thailand. This prospective randomized controlled trial was performed to reassure Thai personnel that this practice was safe, to find the optimum dose of morphine for administration in the PACU, and to find the pain level at which patients needed no more analgesics. Eighty gynecological patients, ASA class I or II, were randomly allocated into two groups. ⋯ We concluded that giving morphine intravenously in the PACU was safe, effective and reduced postoperative analgesic requirement. The dose of morphine in the PACU could be calculated from the pain score at patients' first request for analgesics. Most patients declined additional analgesics when their pain was acceptable and tolerable.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Remifentanil vs morphine for patients in intensive care unit who need short-term mechanical ventilation.
This randomized, double-blind study compared the safety and efficacy of remifentanil (9 microg/ kg/h) with morphine (0.045 mg/kg/h plus a bolus dose of 0.025 mg/kg). One hundred and eighty nine Intensive Care Unit (ICU) patients with normal renal function or mild renal impairment requiring mechanical ventilation were included in this study. A pre-defined dosing algorithm permitted initial titration of the opioids to predetermine the optimal level of sedation and pain score. ⋯ The dosing algorithm facilitated rapid extubation in both groups. Remifentanil provided comparable hemodynamic stability to morphine, and was not associated with an increase in cardiovascular adverse event. Remifentanil is therefore considered to be effective and well tolerated in ICU patients.