ISSN:0265-0215    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0265-0215    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Local and systemic immune and haemostatic responses were studied in 10 patients, aged 57-78 years, undergoing elective hip arthroplasty. Cytokines, soluble cytokine receptors, interleukin-1 receptor antagonist, soluble adhesion molecules, antithrombin, fibrin, soluble and fibrin D-dimer were analysed in wound drainage blood and in blood taken from the systemic circulation for up to 24 h post-operatively. Wound drainage blood concentrations of cytokines, interleukin-1 receptor antagonist and soluble cytokine receptors were increased compared with those in the systemic circulation except for the soluble interleukin-6 receptor. In wound drainage blood, soluble tumour necrosis factor receptors (P<0.05), interleukin-1 receptor antagonist (P<0.05) and interleukin-6 (P<0.05-<0.01) increased during the study period. In blood from the systemic circulation interleukin-6 increased (P<0.05) while the soluble interleukin-6 receptor decreased (P<0.05) compared with pre-operative values. Concentrations of soluble adhesion molecules did not change. Wound drainage blood showed marked hypercoagulation. After hip arthroplasty pro-inflammatory cytokines and their inhibitors were mainly confined to the local trauma site. A predominance for inhibitors was noted.

ISSN:0265-0215    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

A telephone audit was carried out on patients 24 hours after day case surgery. An initial audit shortly after the day case opened indicated pain scores and nausea that were considered unacceptable. Some 8.6% of patients called their family doctor (GP) to visit their home in the post-operative period. Pre-operative Piroxicam 20 mg was then initiated (in most patients) to reduce the pain scores, which it did. Only one patient in 111 (0.9%) called their GP out, but nausea scores remained unchanged. Methods to reduce this index are suggested.

ISSN:0265-0215    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

We have studied the optimal diluent volume for postoperative analgesia and sedation produced by epidurally administered midazolam after upper abdominal surgery. Sixty patients were randomly allocated to four groups of 15 patients. When patients complained of pain after surgery, epidural midazolam 0.05 mg kg−1in 3 mL saline (Group A), in 5 mL saline (Group B), in 10 mL saline (Group C) or in 15 mL saline (Group D) were injected as a bolus. The sedation was better and lasted longer in groups B and C than in the other two groups. Groups B and C also had significantly more extensive areas of analgesia than groups A and D from 30 min after the administration of midazolam. The interval to the second request for an analgesic was significantly shorter in Group D than in the other three groups. Memory retention of the pin-prick examination was reported by four patients in Group A. The present results indicate that 5-10 mL saline is the optimal volume for epidural injection when using midazolam 0.05 mg kg−1for post-operative analgesia following upper abdominal surgery.

ISSN:0265-0215    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Forty-two children (aged 2-16 years) were randomly assigned to receive either sevoflurane (n= 21) or halothane (n= 21) in nitrous oxide/oxygen. After pre-medication with midazolam, anaesthesia was induced by facemask and the anaesthetic concentration was increased until loss of eyelash reflex (sevoflurane, 6%; halothane, 2.5%). Thereafter, 1-1.5 MAC of the inhalational agents were maintained until skin closure. Intra-operative analgesia was provided either by intermittent intravenous (i.v.) bolus doses of fentanyl (2-3 μg kg−1) or by a regional blockade. Induction was smooth and the time to loss of eyelash reflex was slightly shorter with sevoflurane than with halothane, the difference not quite reaching statistical significance (P=0.06). In both groups, heart rate remained stable and blood pressure decreased significantly during induction. Haemodynamic parameters remained stable during anaesthetic maintenance; no cardiac dysrhythmias were observed. Emergence time with sevoflurane was 12.9 min vs. 16.3 min with halothane, but this difference was not statistically significant. It is concluded that sevoflurane is as suitable for paediatric patients as halothane. The slightly faster emergence time offered by sevoflurane over halothane was of no clinical significance in the present study.

ISSN:0265-0215    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

This study was undertaken to determine the minimum effective dose of granisetron, a selective 5-hydroxytryptamine type 3 receptor antagonist, for the prevention of post-operative nausea and vomiting (PONV) in female patients undergoing elective laparoscopic cholecystectomy. In randomized, placebo-controlled, double-blind study, 120 women were assigned to receive either placebo (saline) or granisetron at three different doses (20 μg kg−1, 40 μg kg−1or 80 μg kg−1) intravenously immediately before the induction of anaesthesia. All patients received standardized anaesthesia consisting of isoflurane and nitrous oxide in oxygen. The incidence of PONV during the first 24 hours after anaesthesia was 43, 40, 13 and 13% after administration of placebo and granisetron 20 μg kg−1, 40 μg kg−1and 80 μg kg−1, respectively (P<0.05, overall Fisher's exact probability test). Adverse effects post-operatively were not different among the groups. In conclusion, granisetron 40 μg kg−1is the minimum effective dose in the prevention of PONV after laparoscopic cholecystectomy.

ISSN:0265-0215    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The aim of the present study was to investigate the effect of intravenously (i.v.) administered fentanyl and clonidine on ventilation in 12 healthy male volunteers (age 30.8 ± 4.9 years) who either received fentanyl alone (1.5 ≥ μg kg−1) or fentanyl (1.5 ≥ μg kg−1) in combination with clonidine (3 ≥μg kg−1). The effect on ventilation was measured with a CO2rebreathing system. The respiratory depression caused by fentanyl disappeared 120 min after injection. The corresponding slopes were 7430 ± 2075 mL kPa−1prior to (t0) and 6263 ± 1864 mL kPa−1120 min post-application (base-line vs. t120;P=0.106). An impaired ventilatory response was observed during CO2rebreathing at t120after the injection of fentanyl and clonidine. Before drug administration, the slope of the response curves was 7700±2800 mL kPa−1, which was reduced to 5480±2135 mL kPa−1(P<0.035) at t120. These data suggest a prolongation of a fentanyl-induced ventilatory depression when used in combination with clonidine.

ISSN:0265-0215    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The present study contrasted the pharmaco-economics and analgesic efficacy of intramuscular (i.m.) opioid treatment with a parenteral disposable patientcontrolled analgesia (PCA) system in two groups of 20 female patients (ASA I-II, aged 35-69 years) scheduled for abdominal hysterectomy. The PCA group received a continuous infusion of 1.5 mg h−1piritramide, a μ-opioid receptor agonist, with incremental doses of 1.5 mg (lock-out interval = 15 min). The i.m. group received 0.3 mg kg−1piritramide i.m. when requested by the patient with a minimum interval of 5 h. Pain intensity, sedation and the functional recovery of the patients were followed for 72 h post-operatively. The sum of pain intensity differences (SPID) was used as a measure of analgesic efficiency. Equipment and drug costs, and the demand on nursing time were recorded over 3 days post-operatively. The costs of PCA and i.m. therapies per patient were used to calculate the cost-benefit (cost of treatment vs. nursing time) and cost-effectiveness (cost of treatment vs. SPID) analyses. Both treatments initially provided comparable analgesia, but PCA was more efficient after 16 h and significantly reduced nursing time for pain treatment (PCA=61±4 min, i.m.=88±5 min;P<0.001). Functional recovery was not different for either treatment. Cost analysis indicated a better cost-benefit ratio for the i.m. treatment (0.35 vs. 1.1 for PCA treatment), but a similar cost-effectiveness for both treatments (PCA=1.9 Belgian Francs (BEF) unit−1SPID; i.m.=1.7 BEF unit−1SPID).

ISSN:0265-0215    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Eighty patients were recruited into a double-blind, randomized trial to find the optimal dose of droperidol for addition to the patient-controlled analgesia (PCA) morphine infusate for female patients undergoing gynaecological surgery. A standardized anaesthetic technique was employed. Post-operative analgesia was provided by PCA morphine. Patients were allocated at random into one of four treatment groups receiving with each PCA morphine bolus: (1) droperidol 0.05 mg; (2) droperidol 0.10 mg; (3) droperidol 0.15 mg; and (4) droperidol 0.20 mg, respectively. The incidence of post-operative nausea and vomiting (PONV), requests for rescue anti-emetic medication, and incidence of side effects were recorded. The number of symptom-free patients in each group increased as the droperidol dose increased, but although there was a significant inverse association between the total dose of droperidol received and the severity of PONV (P<0.05), there were no significant differences between individual groups. In each group, patients were significantly less sedated at 24 h compared with 12 h (P<0.01). However, after 24 h, patients in group 4 were significantly more sedated than patients in groups 1 and 2 (P<0.05). There were no significant differences between the groups in terms of the incidence of anxiety or other side effects attributable to droperidol. The present authors suggest that, although the results demonstrate few statistically significant differences between the four groups, a PCA bolus dose of droperidol of 0.10 mg mL−1appears to provide the optimal balance between anti-emetic efficacy and an acceptable incidence of side effects.

ISSN:0265-0215    

出版商:OVID    

年代:1998

数据来源: OVID