Summary
We have studied the effect of alfentanil and midazolam + alfentanil on the conditions for laryngeal mask airway insertion in patients receiving propofol for induction of anaesthesia. Ninety unpremedicated, ASA 1 or 2 adult patients were randomly allocated to one of three groups: group P received propofol only (2.5 mg.kg‐1); group PA received alfentanil (10 μg.kg‐1) followed by propofol (1.25 mg.kg‐1); group PMA received midazolam (0.04 mg.kg‐1) and alfentanil (10 μg.kg‐1) followed by propofol (1.25 mg.kg ‐1). Further boluses of propofol (0.25 mg.kg ‐1 every 15 s) were given if the initial dose was inadequate for induction of anaesthesia. Patients in the midazolam + alfentanil group required less propofol (p < 0.001), had better mouth opening (p < 0.001) and fewer undesired responses to laryngeal mask airway insertion (p < 0.001) than the other two groups.
SummaryIn a randomised, double-blind study, we have compared the incidence of postoperative nausea and vomiting in 124 patients undergoing major lower limb orthopaedic surgery following oral premedication with temazapam and ondansetron 8 mg, metoclopramide 10 mg or placebo. They received a standardised epidural and general anaesthetic. An epidural mixture containing bupivacaine 0.1% and fentanyl 10 mg.ml -1 was infused postoperatively. The occurrence of nausea and vomiting was assessed every 4 h for 24 h. The incidence of vomiting significantly decreased from 55% and 43% in the placebo and metoclopramide groups, respectively, to 26% in the ondansetron group (p = 0.03). The incidence of nausea and vomiting in patients who had previously suffered was also significantly reduced from 67% and 68% in the placebo and metoclopramide groups, respectively, to 29% in the ondansetron group (p = 0.035). We conclude that oral premedication with ondansetron 8 mg was superior to metoclopramide 10 mg and placebo in preventing postoperative nausea and vomiting following major orthopaedic surgery in patients given epidural opioid analgesia.
SummaryIn order to evaluate the contribution of tuba1 spasm to pelvic pain following laparoscopic sterilisation, we have studied the effecr ofglycopyrrolate, an anticholinergic agent with antispasmodic properties, on 60 ASA 1 and 2 patients presenting as day-cases ,for laparoscopic sterilisation using Filshie clips. In a randomised, double-blind, controlled trial, patients received either glycopyrrolate 0.3 mg or saline intravenously prior to induction of anaesthesia. Compared with the control group, patients receiving g1.vcopyrrolate had significantly reduced immediate postoperative pain scores (j < 0.02) and required significantly less postoperutive morphine @ < 0.01). Nausea, vomiting and anti-emetic requirements were also reduced though not significantly.We conclude that glycopyrrolate 0.3 mg at induction of anaesthesia is an effective method of improving the quality of recovery after day-case laparoscopic sterilisation using clips.
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