Comparison of Propofol-Lipuro with propofol mixed with lidocaine 10 mg on propofol injection pain.

A common drawback of propofol is pain on injection and lidocaine is commonly mixed with propofol to reduce its incidence and severity. We conducted a randomised, prospective, double-blind study to compare injection pain following the administration of two different formulations of propofol in 200 unpremedicated ASA I-III adult patients scheduled for elective surgery under general anaesthesia. Patients were allocated randomly into two groups to receive either Propofol-Lipuro without added lidocaine or Diprivan mixed with lidocaine 10 mg. Five ml of the study solution was injected at a constant rate over 15 s and patients graded any associated pain or discomfort using a four-point verbal rating scale. The incidence of propofol injection pain was virtually identical in both study groups with 37/98 (38%) patients experiencing pain or discomfort following Propofol-Lipuro compared with 35/98 (36%) after Diprivan (p = 0.88). We observed no significant difference in pain scores between the groups (p = 0.67). Moderate or severe injection pain was experienced by 12/98 (12%) patients given Propofol-Lipuro compared with 8/98 (8%) given Diprivan (p = 0.48).

Randomised controlled trial investigating the influence of intravenous fluid titration using oesophageal Doppler monitoring during bowel surgery.

Oesophageal Doppler monitoring allows non-invasive estimation of stroke volume and cardiac output. We studied the impact of Doppler guided fluid optimisation on haemodynamic parameters, peri-operative morbidity and hospital stay in patients undergoing major bowel surgery. Fifty-seven patients were randomly assigned to Doppler (D) or control (C) groups. All patients received intra-operative fluid therapy at the discretion of the non-investigating anaesthetist. In addition, Group D were given fluid challenges (3 ml x kg(-1)) guided by oesophageal Doppler. Group D received significantly more intra-operative colloid than Group C (mean 28 (SD 16) vs. 19.4 (SD 14.7) ml x kg(-1), p = 0.02). Cardiac output increased significantly for Group D whilst that of controls remained unchanged. The mean difference between the groups in final cardiac output was 0.87 l x min(-1) (95% confidence interval 0.31-1.43 l x min(-1), p = 0.003). Five control patients required postoperative critical care admission. Fluid titration using oesophageal Doppler during bowel surgery can improve haemodynamic parameters and may reduce critical care admissions postoperatively.

Oral midazolam premedication for day case breast surgery, a randomised prospective double-blind placebo-controlled study.

We conducted a randomised prospective double-blind placebo-controlled study to assess the efficacy of oral midazolam premedication in 50 ASA I and II female patients scheduled to undergo day case breast surgery. Anxiety was assessed using 100-mm visual analogue scales (VAS) and The State-Trait Anxiety Inventory (STAI) psychometric questionnaire. Midazolam premedication did not significantly reduce either VAS or STAI score, although heart rate and systolic arterial pressure immediately before induction of anaesthesia were significantly lower in patients who received midazolam (p = 0.006 and 0.039, respectively). Induction of anaesthesia was achieved with a lower dose of propofol (p = 0.0009) and excellent (Grade I) conditions for insertion of a laryngeal mask airway were achieved more often after midazolam premedication (p = 0.038). Arterial desaturation during induction of anaesthesia and insertion of a laryngeal mask airway occurred more often in patients who received placebo (p = 0.022). There was a good correlation between VAS and STAI used to assess the anxiolytic effects of premedication. (Spearman coefficient 0.58, p < 0.0001).