Subject(s)
Hysterectomy/methods , Laparoscopy/adverse effects , Female , Humans , Laparoscopy/economicsSubject(s)
Laparoscopy , Colonic Neoplasms/surgery , Herniorrhaphy , Humans , Laparoscopy/adverse effectsABSTRACT
Intravenous metoclopramide is known to increase the rate of absorption of oral diazepam if administered at the same time. It has been suggested that oral metoclopramide has the same effect. In this study, six healthy volunteers received oral diazepam (0.2 mg/kg) on two separate occasions, either alone or with oral metoclopramide (10 mg), given simultaneously. In contrast to the effects of intravenous metoclopramide, oral metoclopramide did not increase the rate of absorption of oral diazepam.
Subject(s)
Diazepam/pharmacokinetics , Metoclopramide/pharmacology , Absorption , Administration, Oral , Adult , Diazepam/administration & dosage , Drug Interactions , Female , Humans , Male , Metoclopramide/administration & dosage , Random AllocationABSTRACT
In a prospective randomized multi-centre study, the mortality following internal fixation surgery for fracture of the upper femur was investigated in 538 elderly patients allocated to receive subarachnoid blockade or general (narcotic-relaxant) anaesthesia. The 28-day mortality was 6.6% with subarachnoid, and 5.9% with general, anaesthesia. The difference was not significant (95% confidence limits: -3.5 to +4.8). At 1 year following surgery, the mortality was 20.4%. Increasing age, ischaemic heart disease, cardiac failure, preoperative arrhythmias and poor ASA status were all associated with increases in early and long term mortality. A delay to surgery of more than 24 h from admission was also associated with an increased 28-day mortality. Senile dementia and admission other than from the patient's own home, were factors associated with a poorer long term outcome. From the point of view of mortality, subarachnoid anaesthesia did not appear to confer any advantages over general anaesthesia in non-prosthetic surgery for hip fracture in the elderly.
Subject(s)
Anesthesia, General/mortality , Anesthesia, Spinal/mortality , Hip Fractures/surgery , Aged , Aged, 80 and over , Clinical Trials as Topic , Emergencies , Female , Humans , Male , Postoperative Complications/mortality , Prospective Studies , Random AllocationABSTRACT
In a double-blind, prospective, randomised trial in 30 women undergoing laparoscopy, atracurium and vecuronium were compared in equipotent (2 X ED95) doses. In the atracurium group, first twitch depression was significantly greater at one minute, and degree of fade significantly greater at one and two minutes, but thereafter neuromuscular monitoring showed no significant difference between the groups. Clinically there was no significant difference between the drugs. Mild intraoperative hypotension was equally common in both groups as was sinus bradycardia. Reversal and recovery were comparable in the two groups. Neostigmine was required in all patients and in three (one atracurium, two vecuronium) a second dose was required in all patients and in three (one atracurium, two vecuronium) a second dose was administered on clinical grounds. Antagonism of the neuromuscular block is required with surgery of this duration despite the intermediate duration of action of the relaxant drugs.
Subject(s)
Atracurium/pharmacology , Vecuronium Bromide/pharmacology , Adult , Anesthesia Recovery Period , Anesthesia, Obstetrical , Blood Pressure/drug effects , Double-Blind Method , Female , Heart Rate/drug effects , Humans , Intubation, Intratracheal , Laparoscopy , Prospective Studies , Random AllocationABSTRACT
The pharmacokinetics of morphine were measured using gas chromatography-mass spectrometry (GCMS) with specific ion monitoring after the intramuscular administration of papaveretum to four patients with renal failure (one anephric) and three normals. The apparent t1/2 of absorption and t1/2 of elimination were significantly shorter in the patients with renal failure (P less than 0.05). Morphine glucuronides are eliminated slowly in these patients as expected. Renal failure does not impair the elimination of morphine.
Subject(s)
Kidney Failure, Chronic/metabolism , Morphine/metabolism , Adult , Half-Life , Humans , Injections, Intramuscular , Kidney Failure, Chronic/drug therapy , Kinetics , Male , Middle Aged , Morphine/therapeutic use , Opium/administration & dosage , Opium/metabolismABSTRACT
In a double-blind, prospective, randomised trial in 51 female patients, atracurium 0.6mg/kg provided acceptable intubating conditions more rapidly than did alcuronium 0.25 mg/kg. Atracurium produced more profound neuromuscular twitch suppression than alcuronium. The effect of atracurium was longer-lasting than that of alcuronium (32 minutes and 22 minutes respectively to achieve 10% recovery) and it took slightly longer to reverse with neostigmine. Seven patients in the atracurium group who underwent short surgical procedures required supplementary neostigmine to achieve adequate reversal. Two cases of sinus bradycardia were noted in the atracurium group, but hypotension was not a clinical problem in any patient. Atracurium appears to be a useful relaxant, but a smaller dose than that used here should be chosen for short procedures.
Subject(s)
Alcuronium , Anesthesia, General , Genital Diseases, Female/surgery , Isoquinolines , Neuromuscular Nondepolarizing Agents , Toxiferine , Atracurium , Blood Pressure , Clinical Trials as Topic , Double-Blind Method , Female , Humans , Muscle Contraction/drug effects , Pulse , Random Allocation , Resuscitation , Toxiferine/analogs & derivativesABSTRACT
The theoretical performance of the Hudson Multivent mask is considered. A method is described of determining the flow-weighted mean inspired oxygen concentration produced by the mask. Using this method, it was found that the inspired oxygen concentration was predictable only at the 24% setting using the recommended flow rates, but that increasing the supplied-oxygen flow rates above the recommended levels resulted in the return of predictable function. At settings above 30% predictable function was found to be unlikely, whatever the supplied oxygen flow rate. Recommendations are made regarding the use of this device.
