British medical journal (Clinical research ed.)
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Br Med J (Clin Res Ed) · Mar 1988
Randomized Controlled Trial Clinical TrialDoes halothane anaesthesia decrease the metabolic and endocrine stress responses of newborn infants undergoing operation?
Concern about the side effects of various anaesthetic agents in newborn infants has led to the widespread use of anaesthesia with unsupplemented nitrous oxide and oxygen with muscle relaxants in such patients. To investigate the efficacy of such a regimen 36 neonates undergoing operations were randomised to two groups: one group received anaesthesia with nitrous oxide and curare alone and the other was additionally given halothane. Concentrations of metabolites and hormones were measured before and at the end of operation and at six, 12, and 24 hours after operation and the values compared between the two groups. ⋯ Changes in blood concentrations of glucose and total ketone bodies and plasma concentrations of non-esterified fatty acids were also decreased in neonates receiving halothane anaesthesia. Neonates given anaesthesia with unsupplemented nitrous oxide showed significantly greater increases in the urinary ratio of 3-methylhistidine to creatinine concentration and their clinical condition was also more unstable during and after operation. Unless specifically contraindicated potent anaesthesia with halothane or other anaesthetic agents should be given to all neonates undergoing surgical operations as it decreases their stress responses and improves their clinical stability during and after operation.
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Br Med J (Clin Res Ed) · Dec 1987
Randomized Controlled Trial Clinical TrialInterim discharge summaries: how are they best delivered to general practitioners?
All patients discharged from a medical ward during four months were randomly assigned to one of two groups. In one group the patients were given their interim discharge summary for delivery to their general practitioner by hand; in the other group the summary was posted by the hospital. ⋯ A mean (median) time of two (one) days elapsed before arrival when summaries were delivered by hand and a mean (median) of four and a half (four) days when they were posted; at least 55% of summaries delivered by hand arrived within one day of the day of discharge compared with 8% of those posted. If all interim discharge summaries were given to patients to deliver communication between hospitals and general practitioners would be accelerated and considerable savings might be made.
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Br Med J (Clin Res Ed) · Aug 1987
Randomized Controlled Trial Comparative Study Clinical TrialAccuracy of auscultatory blood pressure measurement with a long cuff.
Intra-arterial blood pressure was compared with simultaneous auscultatory measurements in 37 subjects with a wide range of blood pressures and arm circumferences; six cuffs of various lengths and widths were used. Nineteen subjects had an arm circumference of 34 cm or more (mean 40 cm) and the other 18 were considered to be non-obese and had a mean arm circumference of 30 cm. ⋯ The differences in error among measurements with the four largest cuffs in the obese group (13 X 30 cm, 14 X 30 cm, 14 X 38 cm, and a conical cuff) were clinically irrelevant, and there was even less to choose among all six cuffs in the non-obese subjects. These results suggest that auscultatory blood pressure may be measured with acceptable accuracy with a single long bladdered cuff both in subjects with large arms and in subjects with normal sized arms.
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Br Med J (Clin Res Ed) · May 1987
Randomized Controlled Trial Clinical TrialSuccessful treatment of acute mountain sickness with dexamethasone.
A double blind, randomised, placebo controlled trial of treatment with dexamethasone for acute mountain sickness was performed in the Capanna "Regina Margherita" at an altitude of 4559 m in the Alps Valais. After 12-16 hours of treatment (8 mg dexamethasone initially, followed by 4 mg every six hours) the mean acute mountain sickness score decreased significantly from 5.4 to 1.3, and eight of 17 patients became totally asymptomatic. ⋯ In the placebo group none of these variables changed significantly. It is concluded that dexamethasone may be used as emergency treatment for acute mountain sickness to facilitate safe descent to a lower altitude.
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Br Med J (Clin Res Ed) · Feb 1987
Randomized Controlled Trial Comparative Study Clinical TrialPropofol infusion for sedation in the intensive care unit: preliminary report.
Propofol (2,6,di-isopropylphenol) was given by continuous intravenous infusion to provide sedation after cardiac surgery in 30 patients and its effects compared with those of midazolam given to a further 30 patients. Propofol infusion allowed rapid and accurate control of the level of sedation, which was satisfactory for longer than with midazolam. ⋯ Both medical and nursing staff considered the propofol infusion to be superior to midazolam in these patients. These findings suggest that propofol is a suitable replacement for etomidate and alphaxalone-alphadolone for sedating patients receiving intensive care.