We have compared the dose requirements and side effects of morphine with those of pethidine when administered by patient-controlled analgesia in 40 patients (ASA I-II, 20-65 yr) after elective total abdominal hysterectomy. Patients were allocated randomly, in a double-blind manner, to receive either morphine (bolus dose 2 mg, lockout time 10 min) or pethidine (bolus dose 20 mg, lockout time 10 min) for postoperative pain relief. Mean 24-h morphine and pethidine consumption was 70 (SEM 6.2) mg and 660 (67.8) mg, respectively (ratio 1:9.4). There were no significant differences in postoperative sedation, nausea, pain relief and patient satisfaction (VAS 0-100 mm), and requirements for antiemetics. Four patients receiving pethidine were withdrawn because of postoperative confusion and one receiving morphine because of intractable nausea and vomiting. The 95% confidence interval for this difference between the groups for VAS scores of sedation, nausea and pain were approximately 30 mm.
SummaryWe studied the degree and duration of Local anaesthetic agents are often applied to the upper airway both to facilitate fibreoptic intubation in awake patients and also following induction of general anaesthesia to reduce the reflex physiological effects of tracheal intubation and extubation [I-31. There are very few data available on the effects of these drugs on the sensitivity of upper airway reflexes: the relative effects of different drugs and delivery methods on the sensitivity of upper airway reflexes and the duration of these effects are not well known. This information is important in order to determine optimal methods of producing insensitivity of the upper airway during invasive procedures such as fibreoptic intubation. It is also important to know the duration of depression of upper airway reflexes. The time taken for the return of laryngeal reflexes determines the period that patients may remain at risk from aspiration of food and gastric contents and should therefore refrain from eating and drinking.There are few data on the reduction in the sensitivity of upper airway reflexes and the duration of this effect following the application of topical local anaesthetics. Hinkle and Tantum [4] administered lignocaine to the upper airway in five volunteers but measured only the changes in threshold concentration of ammonia and not the duration of any effect, nor did they make a comparison of the different methods of local anaesthetic delivery to the upper airway; furthermore, the variability in ammonia concentration with the equipment they used was such that the magnitude of effect could not be clearly established. The only other related work involved experiments on anaesthetised cats and piglets [5. 61.With the development in our laboratory of a method to measure the sensitivity of upper airway reflex sensitivity accurately using low concentrations of ammonia vapour [7], we were able to investigate the effects of benzocaine lozenges, lignocaine administered directly onto the vocal cords and lignocaine administered via a nebuliser. The aim of this investigation was to measure the reduction in sensitivity of upper airway reflexes and also to examine the duration of any effect seen.
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