Ibuprofen vs. acetaminophen vs. ibuprofen and acetaminophen after arthroscopically assisted anterior cruciate ligament reconstruction.

BACKGROUND AND OBJECTIVE: The analgesic potency of non-steroidal anti-inflammatory drugs and acetaminophen are still being debated. We have assessed the relative analgesic effect of ibuprofen, acetaminophen or the combination of both after orthopaedic surgery. METHODS: Sixty-one ASA I patients, scheduled for an elective anterior cruciate ligament reconstruction under general anaesthesia were randomized, in a double blind fashion, into one of three groups. The ibuprofen group (n = 17) received ibuprofen 800 mg orally 1 h before operation and again at 6 and 12 h after the initial dose. The acetaminophen group (n = 20) received of acetaminophen 1 g orally at the same time intervals. The combination group (n = 24) received both ibuprofen 800 mg and acetaminophen 1 g. Surgery was performed under general anaesthesia with propofol and fentanyl for induction and maintenance with propofol and nitrous oxide in oxygen. The patients were monitored for 24 h thereafter, and the following variables were assessed: pain by visual analogue and verbal scales, need for rescue intravenous opioid analgesia (i.e. ketobemidone) and adverse events. RESULTS: The ibuprofen group and the combination group experienced significantly less pain during the first 6 h after surgery than the acetaminophen group using the visual analogue and the verbal scales. The acetaminophen group also had a significantly higher average consumption of opioids during the first 6 and 24 h. There were no significant differences between the ibuprofen group and the combination group in respect of experienced pain or consumption of rescue analgesia. The incidence of side-effects, postoperative haemoglobin concentration and renal function, judged by creatinine clearance, were identical between the groups. CONCLUSION: Ibuprofen 800 mg thrice daily reduced pain to a greater degree than acetaminophen 1 g thrice daily, after anterior cruciate ligament reconstruction under general anaesthesia. The combination of acetaminophen and ibuprofen did not provide any superior analgesic effect.

Comparative efficacy and safety of remifentanil and fentanyl in 'fast track' coronary artery bypass graft surgery: a randomized, double-blind study.

This multi-centre, parallel group, randomized, double-blind study compared the efficacy and safety of high-dose remifentanil administered by continuous infusion with an intermittent bolus fentanyl regimen, when given in combination with propofol for general anaesthesia in 321 patients undergoing elective coronary artery bypass graft surgery. A significantly lower proportion of the patients who received remifentanil had responses to maximal sternal spread (the primary efficacy endpoint) compared with those who received fentanyl (11% vs 52%; P<0.001). More patients who received remifentanil responded to tracheal intubation compared with those who received fentanyl (24% vs 9%; P<0.001). However, fewer patients who received remifentanil responded to sternal skin incision (11% vs 36%; P<0.001) and sternotomy (14% vs 60%; P <0.001). Median time to extubation was longer in the subjects who received remifentanil than for those who received fentanyl (5.1 vs 4.2 h; P=0.006). There were no statistically significant differences between the two groups in the times for transfer from intensive care unit or hospital discharge but time to extubation was significantly longer in the remifentanil group. Overall, the incidence of adverse events was similar but greater in the remifentanil group with respect to shivering (P<0.049) and hypertension (P<0.001). Significantly more drug-related adverse events were reported in the remifentanil group (P=0.016). There were no drug-related adverse cardiac outcomes and no deaths from cardiac causes before hospital discharge in either treatment group.

Similar localisation of alpha1- and beta-adrenoceptors in rabbit heart in relation to sympathetic nerve endings.

Electrically driven (1 Hz) rabbit papillary muscles were examined ex vivo for the localisation of the alpha1- and beta-adrenoceptor populations relative to the sympathetic nerve endings and to each other. We determined the influence of neuronal uptake blockade by cocaine upon the horizontal position of the dose-response curves for the inotropic and lusitropic effects exerted by noradrenaline in the presence of extra neuronal uptake blockade by hydrocortisone and in the presence and absence of adrenoceptor blockers. Cocaine similarly shifted the dose-response curves for both alpha1- and beta-adrenoceptors mediated effects to 10-30 times lower concentrations of noradrenaline. This potentiation by cocaine indicates that also the alpha1-adrenoceptor population is located close to or within the sympathetic synaptic clefts, as is known for the beta-adrenoceptor population.

[Out-of-hospital buffer therapy in heart arrest]. / Bufferbehandling ved hjertestans utenfor sykehus.

The effects of infusing a buffer solution on resuscitability and outcome were tested in patients during out-of-hospital cardiac arrest. 502 adults with ventricular fibrillation or asystole with failure of first attempt at defibrillation were entered into a prospective, randomized, double-blind, controlled trial where one group received buffer and the other group placebo (saline). 87 of 245 (36%) patients who received a buffer were admitted to hospital and 24 (10%) were discharged alive, as against 92 of 257 (36%) admitted to hospital and 35 (14%) discharged alive for those who received placebo. Only 16 of the 502 patients had arterial alkalosis on arrival at hospital and no patient had a positive base excess. Patients resuscitated after out-of-hospital cardiac arrest had metabolic acidosis but buffer therapy did not improve outcome.

[Accidental administration of 50 mg racemic adrenaline to a 2-year-old boy]. / Feiladministrering av 50 mg racemisk adrenalin hos en to år gammel gutt.

A two-year-old boy received by mistake 50 mg racemic adrenaline intravenously, corresponding to 1.8 mg kg-1 of L-adrenaline. Blood pressure increased to 160/105 mm Hg, heart rate to 160 beats min-1 and pulmonary oedema developed over the next two hours. He was treated with nitroprusside, nitroglycerine and digitoxin, and was intubated and ventilated. After three hours a hypotensive phase occurred, probably due to down-regulation of the beta- and alpha-adrenoceptors. This recessitated infusions of very high concentrations of catecholamines for 72 hours. Renal failure recessitated renal transplantation, after which the child made an uneventful recovery.

Location of alpha 1-adrenoceptors relative to beta-adrenoceptors in rat myocardium.

Electrically driven rat papillary muscles (1 Hz) were examined for the location of their alpha 1-adrenoceptor and beta-adrenoceptor populations relative to each other. We determined the horizontal position of the dose-response curves for the positive inotropic effects exerted by noradrenaline in the absence and presence of the neuronal uptake blocker cocaine and in the absence and presence of the beta-adrenoceptor antagonist timolol and of the alpha 1-adrenoceptor antagonist prazosin. Cocaine slightly shifted the dose-response curves for alpha 1-adrenoceptor stimulation to a lower concentration of agonist. In contrast, the dose-response curve for beta-adrenoceptor stimulation was markedly shifted by cocaine to a lower concentration of agonist. Experiments with corticosterone (an extraneuronal uptake blocker) revealed no differential shift of either of the dose-response curves. Together, these data indicate that the alpha 1-adrenoceptor population is located more distantly from the adrenergic nerve terminals than the beta 1-adrenoceptor population in rat myocardium.

Buffer therapy during out-of-hospital cardiopulmonary resuscitation.

The effects of infusing a buffer solution on resuscitability and outcome was tested in patients during out-of-hospital cardiac arrest. A number (502) of adults with asystole or ventricular fibrillation with failure of first defibrillation attempt were entered into a prospective, randomized, double-blind, controlled trial. Of these, 245 patients received 250 ml of sodium bicarbonate-trometamol- phosphate mixture with buffering capacity 500 mmol/l and 257 patients received 250 ml 0.9% saline. Except for the investigational infusion, all patients were resuscitated according to international guidelines. Eighty-seven patients (36%) receiving buffer were admitted to hospital ICU and 24 (10%) were discharged from hospital alive, vs. 92 (36%) and 35 (14%) receiving saline (95% confidence interval (CI) for difference between groups: -6%-6% for rate of admission and -1%-9% for rate of discharge). Using a logistic regression analysis, ventricular fibrillation as initial rhythm (odds ratio 8.06, CI 3.70-17.56) improved the outcome, whereas buffer therapy had no effect (odds ratio 0.77, CI 0.43-1.41). Mean base excess at hospital admission was -9 after Tribonat vs. -11 after saline (P = 0.04, CI for difference 0.2-3.8). Only 16 of the 502 patients had arterial alkalosis on arrival in the hospital and no patient had a positive base excess. Patients resuscitated after out-of-hospital cardiac arrest had metabolic acidosis, but buffer therapy did not improve the outcome.

Accidental intravenous administration of 50 mg of racemic adrenaline in a 2-year-old boy.

A 2-year-old boy received, by mistake, 50 mg racemic adrenaline intravenously, equivalent to 1.8 mg kg-1 of L-adrenaline. The blood pressure increased to 160/105 mmHg, the heart rate to 160 beats min-1, and pulmonary oedema developed over the next 2 h. He was treated with nitroprusside, nitroglycerin and digitoxin, and was intubated and ventilated. After 3 h a hypotensive phase occurred which required infusions of very high concentrations of catecholamines for 72 h. Renal failure required renal transplantation after which the child made an uneventful recovery.

[Management of obstructed airways]. / Praktisk om frie luftveier.

Ensuring free passage of air is the first priority in emergency care of patients. Removing obstruction to softtissue, dislodging obstructing foreign bodies and positioning the patient correctly usually secure open airways and respiration in trauma patients. If respiration has ceased, oroendotracheal intubation is necessary and should be performed by trained personnel. Correct control of airways may reduce morbidity and mortality. The author discusses the practical aspects of control of airways and unobstructed respiration.

Congenital abnormalities and growth patterns among cryptorchidic boys.

Congenital abnormalities, birth weight and approximate gestational age among 165 boys operated upon for cryptorchidism were registered. Their growth and sexual development was recorded on the basis of a follow-up questionnaire. We found a high incidence of congenital abnormalities, a slightly reduced birth weight and a high incidence of prematurely born boys. The patients seemed to be somewhat taller and more slender during the prepubertal period than their brothers who served as reference material. This trend seemed to disappear at the onset of puberty. The final height and weight did not differ from the final height and weight among the patients' brothers and fathers. The observed data may indicate that the prepubertal growth of cryptorchidic boys follows a hypogonadic pattern. The incidence of familial occurrence of undescended testes was also registered, 3.9% of the father and 6.5% of the brothers were reported to have undescended testes.