A randomized, placebo-controlled study was conducted in 60 ASA Class I, II, and III patients to determine the dose response of alfentanil in moderating the cardiovascular and catecholamine response to tracheal intubation (INT). Patients were randomly allocated into one of four groups to receive either 15 micrograms/kg alfentanil (A15), 30 micrograms/kg alfentanil (A30), 45 micrograms/kg alfentanil (A45), or normal saline (control), given intravenously (i.v.) before induction of anesthesia. One minute after administration of 4.0 mg/kg thiopental and 1.5 mg/kg succinylcholine i.v., tracheal intubation was performed using direct laryngoscopy. In response to INT, increases in heart rate, systolic blood pressure, and systemic vascular resistance occurred in the control group. These changes were significantly more than corresponding changes of heart rate, systolic blood pressure, and systemic vascular resistance in all three alfentanil groups (P < 0.05). In contrast, cardiac index and ejection fraction decreased moderately in every group during the study period, but there were no differences among groups with respect to either cardiac index or ejection fraction at corresponding times following INT. In the control group, epinephrine and norepinephrine serum concentrations increased by 152 +/- 52% and 58 +/- 62%, respectively, following INT (different from A30 and A45, P < 0.05). However, up to a dose of 30 micrograms/kg (A30), a dose-dependent decrease in the maximum percent changes of both epinephrine and norepinephrine occurred in response to INT. A larger dose of alfentanil was no more efficacious as the catecholamine response to tracheal intubation was not significantly different when comparing the A45 and A30 groups.(ABSTRACT TRUNCATED AT 250 WORDS)
FRCPCPurpose: To compare both the efficacy and cost of nalbuphine and diphenhydramine in the treatment of intrathecal morphine-induced pruritus following Caesarean section. Methods: Eighty patients, undergoing elective Caesarean section under spinal anaesthesia, were randomized, in a prospective, double-blind trial, to receive either nalbuphine (Group NAL) or diphenhydramine (Group DIP) for the treatment of SAB morphine-induced pruritus. All patients received an intrathecal injection of 1 0-12 mg hyperbaric bupivacaine 0.75% and 200 ~tg preservative free morphine. Postoperative pruritus was assessed, using a visual analogue scale (VAS), for 24 hr. Pruritus treatment was administered upon patient request and by a nurse blinded to the treatment given. Patients who failed to respond to three doses of the study drug were deemed treatment failures. Patient satisfaction was assessed with a questionnaire given 24 to 48 hr after surgery. Direct drug costs were calculated based on the pharmacy provision costs as of April 1996. Results: Eighty patients were enrolled and 45 requested treatment for pruritus. Patients treated with NAL (n = 24) were more likely to achieve a VAS score of zero with treatment (83% vs 43%, P < 0.01), had a higher AVAS following treatment (4 + 2 vs 2 ___ 2, P < 0.003), and experienced fewer treatment failures (4% vs 29%, P < 0.04), than those treated with DIP (n = 21 ). Group NAL patients were also more likely to rate their pruritus treatment as being good to excellent (96% vs 57%, P < 0.004). Direct drug costs were higher for NAL than for DIP ($6.4 +_ 3. I vs $1.7 _+ 0.7, respectively, P < 0.0001). Conclusion: Nalbuphine is more effective than diphenhydramine in relieving pruritus caused by intrathecal morphine and the cost differences are small.Objectif : Comparer I'efficacit~ et le cofit de la nalbuphine avec ceux de la diphenhydramine administr6e apr& la c&arienne comme traitement du prurit provoqu~ par la morphine sous-arachndfdienne. M&hodes : Dans cette 6tude prospective en double aveugle, 80 parturientes op6r6es pour une c&arienne non urgente sous rachianesth&ie ont ~t~ r6parties au hasard pour recevoir comme traitement du prurit provoqu6 par la morphine soit de la nalbuphine (groupe NAL), soit de la diphenhydramine (groupe DIP). Toutes les patientes ont re~u une injection sous-arachndidienne de 10-12 mg de bupivac~'ne 0,75% hyperbare avec 200/~g de morphine sans pr&ervatif. Une &helle visuelle analogique (EVA) a servi ~ 6valuer I'intensit~ du prurit postop&atoire pendant 24 h. Le traitement antiprurigineux a &6 administr6 ~ la demande de la patiente et par une inflrmi&e ignorant la nature du traitement. On consid&ait le traitement comme un &hec en I'absence de r6ponse ~trois doses de la drogue &udi&. La satisfaction de la patiente &ait ~valu& avec un questionnaire administr~ 24 ~ 48 h apr& la chirurgie. Les coots d'approvisionnement de la pharmacie en avril 1996 repr~sentaient les coots directs des produits utilis&. R~sttltats : Quarante-cinq des 80 participantes ~ I'&ude ont demand~ un t...
O' = O, 904x + 6, 36, r = O, 92, P 0,001). Les mesures de la PE'rCO 2 ont aussi dEmontrE une bonne correlation avec la PaCO 2 (y = 0,62x + 9,21, r = 0,89, et P < 0,01
This double-blind randomised study compared the analgesic efficacy, respiratory effects, side effects, and pharmacokinetic disposition of 24 hr lumbar epidural and intravenous infusions of the same dosage regimen of fentanyl (1.5 #g" kg -t bolus then 1 l~g" kg -I" hr -~ infusion) in 50 patients
A randomized, double-blind study was undertaken to compare the tendencies for cumulation, and reversal characteristics of atracurium (A TR ) and vecuronium (VEC ) when administered by continuous in fusion for
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