PREMEDICATION WITH SLOW RELEASE MORPHINE (MST) AND ADJUVANTS
|
|
- Amice Blankenship
- 6 years ago
- Views:
Transcription
1 Br. J. Anaesth. (1988), 60, PREMEDICATION WITH SLOW RELEASE MORPHINE (MST) AND ADJUVANTS K. H. SIMPSON, M. J. DEARDEN, F. R. ELLIS AND T. M. JACK Opioids are used widely for premedication, as they produce sedation, contribute to balanced anaesthesia and provide postoperative analgesia. Slow release morphine (MST Continus) has been evaluated for preoperative use, as the convenience of the oral route is attractive and its duration of action is 7-12 h [1, 2]. Kay and Healy [3] found that MST 30 mg, given 2 h before operation, provided sedation and decreased postoperative pain, but they suggested that MST 60 mg might be a more suitable dose. Pinnock and colleagues [4] found that the response to premedication with MST 40 mg was similar to that of morphine 10 mg i.m., both given with atropine 0.6 mg i.m. The present study was designed to evaluate the premedicant properties of MST 60 mg in women having major gynaecological surgery. MST alone was compared with MST with hyoscine 0.6 mg by mouth, to investigate the contribution of an anticholinergic drug to premedication and reduction in adverse effects. MST with diazepam 10 mg by mouth was also studied, as it was shown previously that MST alone did not produce anxiolysis [3, 4]. SUMMARY Sixty-one women undergoing major gynaecological surgery received slow release morphine (MST) 60 mg, with placebo, hyoscine 0.6 mg or diazepam 10 mg. by mouth 2 h before surgery. Plasma morphine concentrations reached a steady level usually within 3 h after administration of MST, and did not increase after surgery unless supplementary opioid was given. Hyoscine delayed morphine absorption. Before operation no fewer than 50 % of patients were sedated after MST alone, but this increased to 85% after MST and diazepam. Similarly, only the combination MST and diazepam produced anxiolysis. Postoperative mood was unhappier after MST and hyoscine. Emesis occurred in 40-57% of patients, and was not reduced by hyoscine. Therefore premedication with MST alone did not produce reliable sedation or anxiolysis. A combination of hyoscine and MST premedication cannot be recommended, as it did not produce sedation, anxiolysis or antiemesis and hyoscine may have delayed morphine absorption. PATIENTS AND METHODS Patient selection and observation Ethics Committee approval was granted for the study which involved 61 women undergoing major gynaecological surgery. All patients were healthy (ASA I or II), aged yr, and none was taking analgesic or psychotropic medication. Two hours before surgery, patients received oral premedication, comprising slow release morpine K. H. SIMPSON, M.B. CH.B., F.F.A.R.C.S.; M. J. DEARDEN, M.B. CH.B., F.F.A.R.C.S.; F. R. ELLIS, PH.D., M.B. CH.B., F.F.A.R.C.S.; University Deparment of Anaesthesia, St James's University Hospital, Beckett Street, Leeds. T. M. JACK, M.B. B.S., M.R.C.S., L.R.C.P., F.F.A.R.C.S.; General Infirmary, Great George Street, Leeds. Accepted for Publication: December 1, Correspondence to K. H. S. 60 mg with placebo (MST-P), hyoscine 0.6 mg (MST-H), or diazepam 10 mg (MST-D), in a double-blind randomized manner. Patients were assessed and questioned by the anaesthetist before premedication, 1 h after premedication and in the anaesthetic, before induction of anaesthesia, using the following rating scales. Sedation: 1 = alert and wide awake; 2 = awake but drowsy; 3 = asleep but easily roused; 4 = asleep not easily roused. Anxiety: 1 = completely calm; 2 = fairly calm; 3 = fairly nervous; 4 = very nervous. Mood: 1 = elated feeling; 2 = pleasant happy feeling; 3 = unhappy feeling; 4 = unpleasant, disturbed feeling. Emesis:
2 826 BRITISH JOURNAL OF ANAESTHESIA 1 = none; 2 = nausea; 3 = nausea and vomiting; 4 = repeated vomiting. A standard anaesthetic was used which involved induction of anaesthesia with thiopentone 3-5 mg kg" 1, paralysis with a competitive neuromuscular blocking drug, tracheal intubation and ventilation of the lungs using 33 % oxygen and 66 % nitrous oxide, with 0.5% halothane if required. All patients received fentanyl (<59kg 0.1 mg, kg 0.15 mg, > 81 kg 0.2 mg). Neuromuscular blockade was antagonized with atropine and neostigmine. The type and duration of surgery were noted. The same anaesthetist recorded sedation, anxiety, mood and emesis scores immediately after the patient was admitted to the recovery, and at 1, 2 and 3 h after operation. Pain was assessed also at these times, using a 10-cm visual analogue score and a fourpoint rating. scale: 1 = none; 2 = mild; 3 = moderate; 4 = severe. Postoperative analgesia was given on demand as i.m. papaveretum (<59kg 10 mg, kg 15 mg, > 81 kg 20 mg), and emesis was treated with prochlorperazine 12.5 mg i.m. The time of administration of the first dose of postoperative opioid was recorded. Plasma morphine, catecholamine and cortisol measurement Venous blood was sampled before induction of anaesthesia, in the recovery and 2 h after surgery for measurement of morphine, catecholamine and cortisol concentrations. Blood samples were collected into heparinized glass tubes on ice, siliconized for morphine assay or containing EDTA and glutathione for catecholamine assay. Plasma was stored at 20 C until required for assay. Morphine was measured using a radioimmunoassay, with a prior liquid-solid extraction to reduce cross-reactivity with glucuronides. All results were expressed as morphine base, and the lowest limit of detection was 2-3ngml"'. The mean deviation of measured values from standard values was 8.1 %. Plasma adrenaline and noradrenaline concentrations were measured using high performance liquid chromatography and electrochemical detection. Catecholamines were separated on a column using a mobile buffer, and extraction was performed using the method of Hjemdahl, Daleskog and Kahan [5]. A mixture of adrenaline, noradrenaline and dihydroxybenzylamine was used as an extracted standard, and dihydroxybenzylamine was used as an internal standard. The lowest limit of detection was 0.05 nmol litre" 1 for adrenaline and 0.10 nmol litre" 1 for noradrenaline. The intra-assay coefficient of variation was 11.0% for adrenaline and 6.7 % for noradrenaline. Plasma cortisol concentrations were measured using a radioimmunoassay kit (RIA U.K. Ltd), which used on antibody covalently bound to the inner surface of a polypropylene tube and 125 I- cortisol. The lowest limit of detection was 1.1 nmol litre" 1. The interassay coefficient of variation was 5.0% and the intra-assay coefficient of variation was 5.7%. Statistics Parametric data were analysed using the Pearson product moment correlation coefficient, t test, one-way analysis of variance for independent groups and two-way analysis of variance with repeated measures on one factor, followed by the Tukey test where appropriate. Non-parametric data, including pain scores, were analysed using Chi-square and Kruskal- Wallis analysis of variance. Differences in sedation, anxiety and mood scores in each group, at each time, were analysed using the Mann- Whitney U test. Differences in scores before and after premedication were analysed using the Wilcoxon matched pairs signed ranks test. RESULTS The ages and weights of patients in the three groups were not significantly different. Fourteen patients received premedication more than 15 min early, and three patients received premedication more than 15 min late. The doses of thiopentone, fentanyl and the use of halothane were comparable in each group. The type and duration of surgery were similar in the three groups (table I). Morphine absorption Before induction of anaesthesia mean (SD) plasma morphine concentrations were not significantly different in patients who had received morphine on time (19.6 (6.3) ngml" 1 ) compared with those who had not (19.9 (6.6) ngml" 1 ). Plasma morphine concentrations in the anaesthetic and recovery s were not significantly different; however, plasma concentrations were lower after MST-H compared with MST-D
3 SLOW RELEASE MORPHINE (MST) PREMEDICATION 827 TABLE I. Mean (SD) age and weight, details of surgery and mean (SD) time of first dose of postoperative opioid in each group MST-P = MST+placebo; MST-H = MST+hyoscine; MST-D = MST+ diazepatn. No significant difference between groups in age (f = 1.45) or weight (f = 1.63). No significant difference between groups in type (Chi square = 1.43) or duration (f = 1.04) of operation. No significant difference between groups in time of opioid administration after surgery (f = 0.04) or after premedication MST-P («= 21) MST-H (n = 20) MST-D (n = 20) Age (yr) Weight (kg) Abdominal surgery Vaginal surgery Duration of surgery (min) Time of first analgesia After surgery (h) After premed. (h) 44.1 (8.7) 62.9 (16.9) (30.3) 4.4 (23.0) 8.2 (23.8) 42.5 (6.7) 68.4 (12.0) (22.7) 3.4 (14.8) 6.4(11.6) 39.9 (8.5) 64.0 (6.3) (30.0) 3.4 (7.3) 6.9 (7.3) 30 r I o MST- P» MST-H MST- D Anaesthetic! Awake Asleep 18.6 (6.3) 20.6 (9.8) 2 h 24.5(18.1) 33.0(17.1)* (P < 0.01) (fig. 1). Thirty-two patients required papaveretum during the first 2 h after surgery, before the third blood sample was obtained for morphine assay. Mean (SD) plasma morphine concentrations were significantly higher when i.m. opioid had been given (41.6 (15.8) ngml" 1 ) compared with when it had not (16.9 (7.0) ng ml" 1 ) (t = 7.8, P < 0.01). Only one patient, who had received MST-H, showed an increase in plasma morphine without receiving i.m. opioid, from 7.8 ngml" 1 in the recovery, to 19 ngml" 1 2 h later. Sedation No patient was sedated before receiving MST Time (min) and adjuvants, and all groups showed significant FIG. 1. Plasma morphine concentrations (mean + SEM) at sedation after premedication and after operation each time after premedication. Closed symbols show data from all patients (MST-P n = 21, MST-H n = 20, MST-D (P < 0.001). One hour after premedication, more n = 20), open symbols show data from patients who had not patients were sedated after MST-D (95%) received supplementary opioid at the time of the final blood compared with MST-P (62 %) or MST-H (55 %) sample (MST-P n= 11, MST-H n = 8, MST-D n= 10). (P < 0.05). There was no significant difference in Plasma morphine concentrations not significantly different at each time (/= 0.11). Plasma morphine concentrations significantly lower after MST-H compared with MST-D, in the : MST-P 62%, MST-H 60% and MST-D sedation between the groups in the anaesthetic anaesthetic and recovery s (f' 5.78, P < 0.01). 85%. The number of patients sedated at both preoperative assessments was significantly greater after MST-D (85%) than MST-P (48%) and TABLE II. Mean (SD) plasma morphine base concentrationsmst-h (35 %) (P < 0.05). After operation there (ng tng' 1 ) in n 61 patients classified as awake or asleep\ *Significantly greater than awake (t: 2.04, P< 0.05)) were no significant differences between the groups: MST-P 86 %, MST-H 90 % and MST-D 100%. Inadequate sedation occurred more often after MST-P and MST-H than after MST-D (P<0.01), and oversedation occurred in four patients, two MST-P, one MST-H and one
4 828 MST-D. Sedation in the recovery was not related to plasma morphine concentration; however, 2 h after operation morphine concentrations were greater in patients who were asleep compared with those who were awake (P < 0.05) (table II). Anxiety Before premedication, there were no significant differences in anxiety between the groups. Only MST-D patients showed significant anxiolysis in the anaesthetic (P < 0.001); MST-D patients were less anxious than MST-P or MST-H (P < 0.05). Anxiety was reduced in all groups after surgery (P < 0.05). BRITISH JOURNAL OF ANAESTHESIA \ 1 Abdominal surgery (n.38) I Vaginal surgery (n. 23) h 3h FIG. 2. Percent of patients at each time, after abdominal or vaginal surgery, with no pain or mild pain. The type of surgery had no effect on postoperative pain: pain scores were not significantly different during the first 3 h after abdominal or vaginal operations (fig. 2). Severe pain occurred in only 17 % patients after vaginal surgery, and 18 % patients after abdominal surgery. The mean (SD) time to administration of the first supplementary opioid was not significantly different after vaginal surgery (4.6 (2.9) h), compared with abdominal surgery (3.1 (4.7) h). Surprisingly, the present study showed that pain was not significantly different after abdominal or vaginal surgery. Nearly 30% of the patients did not require supplementary analgesia within the first 4 h after surgery, which was approximately 7 h after premedication. Patients who had received MST Emesis and diazepam seemed to complain of less pain The incidence of emesis was not significantly than the other two groups; this was not related to different in the three groups: 57 % MST-P, 45 % increased sedation. MST-H and 40 % MST-D patients suffered from 1.4 nausea, vomiting, or both. There was no sig MST-P (n-21) nificant relationship between emesis and plasma MST-H (n.20) MST-D(n.20) morphine concentrations. Mood A simple rating of happiness was used in the present study, but unhappy mood because of pain was specifically excluded. Mood scores before surgery were similar in the three groups but, after operation, patients were unhappier after hyoscine than after diazepam. Premedication did not significantly alter preoperative mood scores in any group. However, MST-H patients were unhappier than MST-D patients at 1 and 2 h after operation (P < 0.05). Unhappy mood was recorded significantly more often after MST-H compared with MST-D (P < 0.01) and MST-P (P < 0.05). Pain The ranked 10-cm visual analogue pain scores correlated well with the four-point ranking system (r = 0.69, t = 14.4, P < 0.01), and there was disparity between the two scoring systems on only 7.8% occasions. Analysis of pain scores showed that, at 1 and 2 h after operation, pain was reduced after MST-D compared with MST-H and, at 3 h, pain was reduced after MST-D compared with MST-H and MST-P (P < 0.05). Twenty-five percent of patients needed supplementary analgesia within 90 min, 52 % within 2 h and 69 % within 4 h. The time of first postoperative analgesia was not significantly different in the three groups (table I). I to c 1-8 C Q> S 0.4 II (A I 0.2 Anaesthetic FIG. 3. Plasma adrenaline concentrations (mean + SEM) increased in the recovery compared with in the anaesthetic, in all three groups (/= 3.5, P < 0.05). No significant differences between the three premedication regimens.
5 SLOW RELEASE MORPHINE (MST) PREMEDICATION 829 "V» 5 MST-P(n.2D MST-H (n.20) MST-D (n.20) Catecholamine concentrations Plasma adrenaline concentrations were riot significantly different after the three premedication regimens (fig. 3). Overall plasma adrenaline concentrations increased in the recovery compared with in the anaesthetic (P<0.05); however, there was no significant difference between adrenaline concentrations in the recovery and at 2 h after surgery. In the three groups plasma noradrenaline concentrations increased in the recovery, at 2 h after operation (P < 0.01). Plasma noradrenaline concentrations were lower after MST-D compared with MST-H (P < 0.05) (fig. 4). Postoperative adrenaline and noradrenaline concentrations were greater in patients who were asleep compared with those who were awake (P < 0.05). Plasma catecholamine concentrations were not related to anxiety, mood, pain or plasma morphine concentrations. Anaesthetic FIG. 4. Plasma noradrenaline concentrations (mean + SEM) increased in the recovery and after operation in all three groups (J = 5.08, P<0.01). Noradrenaline concentrations were reduced after MST-D compared with MST-H (/=3.19, P<0.05). '(D o j 600 c u I CO (0 _C0 " Anaesthetic MST-P (n-21) MST-H (n.20).mst-d (n.20) II FIG. 5. Plasma cortisol concentrations (mean + SEM) increased, in all three groups, in the recovery and after operation (f = 158.6, P < 0.01). Cortisol concentrations Plasma cortisol concentrations increased in the recovery and after operation, compared with values in the anaesthetic (P < 0.01), but there was no significant difference in cortisol concentrations between the three groups (fig. 5). Plasma cortisol concentrations were not related to plasma morphine concentrations, pain, sedation or anxiety. DISCUSSION The perioperative use of MST is not now recommended, because of concern regarding delayed absorption of morphine in the presence of decreased gastric emptying, produced by pharmacological or pathological causes [6]. The present study, commenced early in 1984, has shown that one preoperative dose of MST, given to healthy patients, was absorbed well and that the timing of its administration was not critical. If supplementary opioid was not needed, plasma morphine concentrations remained fairly stable throughout the study period. Peak plasma morphine concentrations were reached in the anaesthetic or recovery in all but one patient, who had received MST and hyoscine and in whom plasma morphine concentration increased at 2 h after operation. Perhaps the anticholinergic drug had slowed gastric emptying sufficiently to delay morphine absorption from the small intestine. In support of this hypothesis, patients who received MST and hyoscine had lower preoperative plasma morphine concentrations than those who received MST and diazepam. Preoperative anxiety decreases gastric emptying [7], therefore anxiolysis following diazepam may have promoted morphine absorption, whilst gastric stasis following hyoscine may have had the opposite effect. Forty-eight percent of patients did not receive further analgesia before blood was sampled 2 h after operation. Plasma morphine concentrations were not increased in these patients, approximately 5 h after MST administration, remaining
6 830 BRITISH JOURNAL OF ANAESTHESIA stable after surgery, therefore the use of supplementary i.m. opioid appeared to be safe in this group of patients. However, a marked increase in plasma morphine concentration occurred after i.m. papaveretum. The present study confirmed previous observations of significant sedation when MST premedication was administered [3, 4]. However, although sedation occurred in all three groups, the addition of diazepam to MST produced more predictable results, with 85 % of patients sedated at both assessments. As fewer than 50% of the patients were drowsy or asleep at 1 and 2 h after MST alone or with hyoscine, these regimens cannot be recommended. Postoperative sedation was shown to be associated with higher plasma morphine and catecholamine concentrations. Increased catecholamine concentrations may have been associated with pain, which resulted in the administration of supplementary opioid and consequent sedation. Anxiety is difficult to measure, and several scoring systems have been used before operation. In the present study, a four-point rating scale was chosen for simplicity and brevity. A predictable postoperative reduction in anxiety [8] was detected, suggesting that the rating system was sensitive to acute changes. Reduction of apprehension is an important feature of good premedication, and the lack of anxiolysis after MST alone, shown previously [3, 4], was confirmed in the present study. It was also demonstrated that the addition of hyoscine to MST did not improve anxiolysis, whereas diazepam was effective. Overall, unhappy mood was seen more often after MST and hyoscine than after MST alone or with diazepam. It has been suggested that postoperative emesis occurs in 20-40% of all surgical patients [9]; however, in the present study, 57 % of patients suffered from nausea and vomiting after MST and placebo. The occurrence of emesis was not related to plasma morphine concentrations. Hyoscine premedication has been shown to reduce postoperative emesis [10], but its duration of action is short; the failure of hyoscine to reduce nausea and vomiting significantly in the present study may therefore have been a result of the prolonged action of MST. In conclusion, sedation was unpredictable and there was no anxiolysis when MST alone was used before operation; the addition of diazepam was necessary to improve the quality of premedication. The use of hyoscine with MST cannot be recommended, as it did not improve sedation, worsened mood and did not decrease the rather high incidence of emesis; it may also have delayed the absorption or morphine. (Since 1984 the perioperative use of MST has not been recommended by the manufacturers (Napp Laboratories).) ACKNOWLEDGEMENTS We are grateful to Mrs E. Hay and Mr P. Allam (University Department of Anaesthesia, St James's University Hospital) for the performance of catecholamine assays, and to Dr R. Evans and Dr Shapiro (Department of Chemical Pathology, St James's University Hospital) for provision of cortisol assays. We are indebted to Mrs Elizabeth Tonge, Clinical Research Associate, Napp Laboratories, for support, provision of MST used during the study and organization of the morphine assay. We also thank Dr A. Judd and the staff of the Yorkshire Regional Drug Information Centre for providing the placebo and randomizing the tablets for the study. REFERENCES 1. Leslie ST, Rhodes A, Black FM. Controlled release morphine sulphate tablets a study in normal volunteers. British Journal of Clinical Pharmacology 1980; 9: Vater M, Smith G, Aherne GW, Aitkenhead AR. Pharmacokinetics and analgesic effect of slow-release oral morphine sulphate in volunteers. British Journal of Anaesthesia 1984; 56: Kay B, Healy TEJ. Premedication by controlled-release morphine. Anaesthesia 1984; 39: Pinnock CA, Derbyshire DR, Elling AE, Smith G. Comparison of oral slow release morphine (MST) with intramuscular morphine for premedication. Anaesthesia 1985; 40: Hjemdahl P, Daleskog M, Kahan T. Determination of plasma catecholamines using liquid chromatography with electrochemical detection: comparison with radioenzymatic method. Life Sciences 1979; 25: Brahams A. Death of patient participating in trial of oral morphine for relief of postoperative pain. Lancet 1984; 1, Simpson KH, Stakes AF. Effect of anxiety on gastric emptying in preoperative patients. British Journal of Anaesthesia 1987; 59: Wassenaar W, Lancee WJ, Galloon S, Gale GD. The measurement of anxiety in the presurgical patient. British Journal of Anaesthesia 1977; 49: Palazzo MGA, Strunih L. Anaesthesia and emesis: prevention and management. Canadian Anaesthetists Society Journal 1984; 31: Clarke RSJ, Dundee JW, Love WJ. Studies of drugs given before anaesthesia VIII. Morphine 10 mg alone and with atropine or hyoscine. British Journal of Anaesthesia 1965; 37:
PREMEDICATION WITH PIROXICAM IN PATIENTS HAVING DENTAL SURGERY UNDER GENERAL ANAESTHESIA WITH HALOTHANE OR ISOFLURANE
Br. J. Anaesth. (1988), 61, 702-706 PREMEDICATION WITH PIROXICAM IN PATIENTS HAVING DENTAL SURGERY UNDER GENERAL ANAESTHESIA WITH HALOTHANE OR ISOFLURANE M. PARSLOE, S. N. CHATER, M. BEMBRIDGE AND K. H.
More informationFENTANYL BY CONSTANT RATE I.V. INFUSION FOR POSTOPERATIVE ANALGESIA
Br. J. Anaesth. (1985), 5, 250-254 FENTANYL BY CONSTANT RATE I.V. INFUSION FOR POSTOPERATIVE ANALGESIA W. S. NIMMO AND J. G. TODD is a synthetic opioid analgesic 50 times more potent than morphine, with
More informationD. R. DERBYSHIRE, A. BELL, P. A. PARRY AND G. SMITH
Br. J. Anaesth. (1985), 57, 858-865 MORPHINE SULPHATE SLOW RELEASE Comparison with i.m. Morphine for Postoperative Analgesia D. R. DERBYSHIRE, A. BELL, P. A. PARRY AND G. SMITH There has been increasing
More informationIBUPROFEN IN THE MANAGEMENT OF POSTOPERATIVE PAIN
Br.J. Anaesth. (1986), 58, 171-175 IBUPROFEN IN THE MANAGEMENT OF POSTOPERATIVE PAIN H. OWEN, R. J. GLAVIN AND N. A. SHAW In addition to the control of symptoms associated with arthritis, non-steroidal
More informationPLASMA FENTANYL CONCENTRATIONS DURING TRANSDERMAL DELIVERY OF FENTANYL TO SURGICAL PATIENTS
Br. J. Anaesth. (988), 6, 64-68 PLASMA FENTANYL CONCENTRATIONS DURING TRANSDERMAL DELIVERY OF FENTANYL TO SURGICAL PATIENTS D. J. R. DUTHIE, D. J. ROWBOTHAM, R. WYLD, P. D. HENDERSON AND W. S. NIMMO Pain
More informationDROPERIDOL, FENTANYL AND MORPHINE FOR I.V. SURGICAL PREMEDICATION
Br.J. Anaesth. (97),, 463 DROPERIDOL, FENTANYL AND MORPHINE FOR I.V. SURGICAL PREMEDICATION J. T. CONNER, G. HERR, R. L. KATZ, F. DOREY, R. R. PAGANO AND D. SCHEHL SUMMARY. mg and morphine mg alone and
More informationSINGLE BREATH INDUCTION OF ANAESTHESIA WITH ISOFLURANE
Br. J. Anaesth. (987), 59, 24-28 SINGLE BREATH INDUCTION OF ANAESTHESIA WITH ISOFLURANE J. M. LAMBERTY AND I. H. WILSON Two studies have demonstrated that the induction of anaesthesia using a single breath
More informationEvaluation of Oral Midazolam as Pre-Medication in Day Care Surgery in Adult Pakistani Patients
Evaluation of Oral Midazolam as Pre-Medication in Day Care Surgery in Adult Pakistani Patients Abstract Pages with reference to book, From 239 To 241 Nauman Ahmed, Fauzia A. Khan ( Department of Anaesthesia,
More informationOral Midazolam for Premedication in Children Undergoing Various Elective Surgical procedures
Oral Midazolam for Premedication in Children Undergoing Various Elective Surgical procedures E-mail gauripanjabi@yahoo.co.in 1 st Author:. Dr Panjabi Gauri M., M.D., D.A., Senior Assistant professor. 2
More informationEFFECTS OF POSTURE AND BARICITY ON SPINAL ANAESTHESIA WITH 0.5 % BUPIVACAINE 5 ML
Br.J. Anaesth. (1988), 61, 139-143 EFFECTS OF POSTURE AND BARICITY ON SPINAL ANAESTHESIA WITH 0.5 % BUPIVACAINE 5 ML A Double-Blind Study R. W. D. MITCHELL, G. M. R. BOWLER, D. B. SCOTT AND H. H. EDSTROM
More informationPOST-TETANIC COUNT AND PROFOUND NEUROMUSCULAR BLOCKADE WITH ATRACURIUM INFUSION IN PAEDIATRIC PATIENTS
Br. J. Anaesth. (9), 60, 3-35 POST-TETANIC COUNT AND PROFOUND NEUROMUSCULAR BLOCKADE WITH ATRACURIUM INFUSION IN PAEDIATRIC PATIENTS S. A. RIDLEY AND D. J. HATCH Atracurium degrades rapidly and, because
More informationEfficacy of a single-dose ondansetron for preventing post-operative nausea and vomiting
European Review for Medical and Pharmacological Sciences 2001; 5: 59-63 Efficacy of a single-dose ondansetron for preventing post-operative nausea and vomiting after laparoscopic cholecystectomy with sevoflurane
More informationPHARMACOKINETICS OF FENTANYL DURING CONSTANT RATE I.V. INFUSION FOR THE RELIEF OF PAIN AFTER SURGERY
Br. J. Anaesth. (1986), 58, 950-956 PHARMACOKINETICS OF FENTANYL DURING CONSTANT RATE I.V. INFUSION FOR THE RELIEF OF PAIN AFTER SURGERY D. J. R. DUTHIE, A. D. McLAREN AND W. S. NIMMO Acute pain after
More informationEFFICACY OF ORALLY ADMINISTERED ONDANSETRON IN THE PREVENTION OF POSTOPERATIVE NAUSEA AND VOMITING: A DOSE RANGING STUDY
British Journal of Anaesthesia 1992; 68: 466-^47 EFFICACY OF ORALLY ADMINISTERED ONDANSETRON IN THE PREVENTION OF POSTOPERATIVE NAUSEA AND VOMITING: A DOSE RANGING STUDY G. N. C. KENNY, J. D. L. OATES,
More informationLOGISTIC REGRESSION ANALYSIS OF FIXED PATIENT FACTORS FOR POSTOPERATIVE SICKNESS: A MODEL FOR RISK ASSESSMENT
British Journal of Anaesthesia 1993; 70: 135-140 LOGISTIC REGRESSION ANALYSIS OF FIXED PATIENT FACTORS FOR POSTOPERATIVE SICKNESS: A MODEL FOR RISK ASSESSMENT M. PALAZZO AND R. EVANS SUMMARY One hundred
More informationPrevention of emergence phenomena after ketamine anaesthesia: A comparative study on diazepam vis-a-vis midazolam in young female subjects
World Journal of Pharmaceutical Sciences ISSN (Print): 2321-3310; ISSN (Online): 2321-3086 Published by Atom and Cell Publishers All Rights Reserved Available online at: http://www.wjpsonline.org/ Original
More informationGeneral anesthetics. Dr. Shamil AL-Noaimy Lecturer of Pharmacology Dept. of Pharmacology College of Medicine
General anesthetics Dr. Shamil AL-Noaimy Lecturer of Pharmacology Dept. of Pharmacology College of Medicine Rationale General anesthesia is essential to surgical practice, because it renders patients analgesic,
More informationPREMEDICATION BEFORE DAY SURGERY
Br.J. Anaesth. (1985), 57, -5 REMEDICATION BEFORE DAY SURGERY A Double-Blind Comparison ofdiazepam and lacebo H. JAKOBSEN, J. B. HERTZ, J. R. JOHANSEN, A. HANSEN AND K. KLLIKER The benzodiazepines are
More informationPREOPERATIVE SEDATION BEFORE REGIONAL ANAESTHESIA: COMPARISON BETWEEN ZOLPIDEM, MIDAZOLAM AND PLACEBO
British Journal of Anaesthesia 1990; 64: 670-674 PREOPERATIVE SEDATION BEFORE REGIONAL ANAESTHESIA: COMPARISON BETWEEN ZOLPIDEM, MIDAZOLAM AND PLACEBO J. PRAPLAN-PAHUD, A. FORSTER, Z. GAMULIN, E. TASSONYI
More informationPharmacological methods of behaviour management
Pharmacological methods of behaviour management Pharmacological methods CONCIOUS SEDATION?? Sedation is the use of a mild sedative (calming drug) to manage special needs or anxiety while a child receives
More informationClinical Evaluation of Isoflurane DEMOGRAPHY OF PATIENT POPULATION JAMES B. FORREST
Clinical Evaluation of Isoflurane DEMOGRAPHY OF PATIENT POPULATION JAMES B. FORREST SINCE THE AIM of the clinical evaluation of isoflurane was to assess its efficacy and safety in a wide spectrum of clinical
More informationInternational Journal of Drug Delivery 5 (2013) Original Research Article
International Journal of Drug Delivery 5 (2013) 239-244 http://www.arjournals.org/index.php/ijdd/index Original Research Article ISSN: 0975-0215 Comparative study of duration of analgesia with epidural
More informationAntiemetic and analgesic-sparing effects of diphenhydramine added to morphine intravenous patient-controlled analgesia
British Journal of Anaesthesia 94 (6): 835 9 (2005) doi:10.1093/bja/aei137 Advance Access publication April 15, 2005 Antiemetic and analgesic-sparing effects of diphenhydramine added to morphine intravenous
More informationControlled Trial of Wound Infiltration with Bupivacaine for Post Operative Pain Relief after Caesarean Section
Bahrain Medical Bulletin, Vol.23, No.2, June 2001 Controlled Trial of Wound Infiltration with Bupivacaine for Post Operative Pain Relief after Caesarean Section Omar Momani, MD, MBBS, JBA* Objective: The
More informationPrevention of postoperative nausea and vomiting with transdermal hyoscine in children using patient-controlled analgesia
British Journal of Anaesthesia 994; 72: 72-7 Prevention of postoperative nausea and vomiting with transdermal hyoscine in children using patient-controlled analgesia E. DOYLE, G. BYERS, L. R. MCNICOL AND
More informationKetoprofen, diclofenac or ketorolac for pain after tonsillectomy in adults?
British Journal of Anaesthesia 82 (1): 56 60 (1999) Ketoprofen, diclofenac or ketorolac for pain after tonsillectomy in adults? P. Tarkkila* and L. Saarnivaara Department of Anaesthesia, Otolaryngological
More informationSEDATION DURING SPINAL ANAESTHESIA: COMPARISON OF PROPOFOL AND MIDAZOLAM
British Journal of Anaesthesia 1990; 64: 48-52 SEDATION DURING SPINAL ANAESTHESIA: COMPARISON OF PROPOFOL AND MIDAZOLAM E. WILSON, A. DAVID, N. MACKENZIE AND I. S. GRANT SUMMARY Propofol and midazolam
More informationComparison of Drug Clonidine and Midazolam as Premedication s in Children: An Institutional Based Study
Original article: Comparison of Drug Clonidine and Midazolam as Premedication s in Children: An Institutional Based Study Dr. Gurdeep Singh Jheetay Associate Professor, Department of Anaesthesia, Shri
More informationPARA VERTEBRAL BLOCK DURING CHOLECYSTECTOMY EFFECTS ON CIRCULATORY AND HORMONAL RESPONSES
Br. J. Anaesth. (988), 6, 652-656 PARA VERTEBRAL BLOCK DURING CHOLECYSTECTOMY EFFECTS ON CIRCULATORY AND HORMONAL RESPONSES K. GIESECKE, B. HAMBERGER, P.-O. JARNBERG AND C. KLINGSTEDT Paravertebral block
More informationSedation in Children
CHILDREN S SERVICES Sedation in Children See text for full explanation and drug doses Patient for Sedation Appropriate staffing Resuscitation equipment available Monitoring equipment Patient suitability
More informationAn evaluation of different doses of soluble aspirin and aspirin tablets in postoperative dental pain
Br. J. clin. Pharmac. (1988), 26, 463-468 An evaluation of different doses of soluble aspirin and aspirin tablets in postoperative dental pain I. S. HOLLAND', R. A. SEYMOUR2, R. P. WARD-BOOTH', R. A. ORD',
More informationPSYCHOMETRY AND POSTOPERATIVE COMPLAINTS IN SURGICAL PATIENTS
Brit. J. Anaesth. (973), 45, 879 PSYCHOMETRY AND POSTOPERATIVE COMPLAINTS IN SURGICAL PATIENTS M. CRONIN, P. A. REDFERN AND J. E. UTTING SUMMARY One hundred general surgical patients were subjected to
More informationThe effect of duration of dose delivery with patient-controlled analgesia on the incidence of nausea and vomiting after hysterectomy
Br J Clin Pharmacol 1998; 45: 57 62 The effect of duration of dose delivery with patient-controlled analgesia on the incidence of nausea and vomiting after hysterectomy Annie Woodhouse* & Laurence E. Mather
More informationPreliminary studies of the pharmacokinetics and pharmacodynamics
Br. J. clin. Pharmac. (1987), 23, 137-142 Preliminary studies of the pharmacokinetics and pharmacodynamics of prochlorperazine in healthy volunteers WENDY B. TAYLOR & D. N. BATEMAN Wolfson Unit of Clinical
More informationAs laparoscopic surgeries are gaining popularity, Original Article. Maharjan SK 1, Shrestha S 2 1. Introduction
, Vol. 1, No. 1, Issue 1, Jul.-Sep., 2012 Original Article Maharjan SK 1, Shrestha S 2 1 Associate Professor, 2 Assistant Professor, Department of Anaesthesiology and Intensive Care Kathmandu Medical College,
More informationResearch Article. Shital S. Ahire 1 *, Shweta Mhambrey 1, Sambharana Nayak 2. Received: 22 July 2016 Accepted: 08 August 2016
International Journal of Research in Medical Sciences Ahire SS et al. Int J Res Med Sci. 2016 Sep;4(9):3838-3844 www.msjonline.org pissn 2320-6071 eissn 2320-6012 Research Article DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20162824
More informationPaediatric Premedication: A Comparison of Sublingual Buprenorphine and Midazolam in Children (4-10 Years) Scheduled for Adenotonsillectomy
0000-0000/02/11-12-16 IRANIAN JOURNAL OF PHARMACOLOGY & THERAPEUTICS Copyright 2002 by Razi Institute for Drug Research (RIDR) IJPT 1:12-16, 2002 Paediatric Premedication: A Comparison of Sublingual Buprenorphine
More informationA Comparative Clinical Study Of Prevention Of PostOperative Nausea And Vomiting Using Granisetron And
ISPUB.COM The Internet Journal of Anesthesiology Volume 26 Number 1 A Comparative Clinical Study Of Prevention Of PostOperative Nausea And Vomiting Using Granisetron And Ondansetron In Laparoscopic Surgeries.
More informationANTIHISTAMINE DRUGS IN PRE-ANAESTHETIC MEDICATION: BLIND STUDIES ON 953 PATIENTS
Brit. J. Anaesth. (196), 32, 82 ANTIHISTAMINE DRUGS IN PRE-ANAESTHETIC MEDICATION: BLIND STUDIES ON 93 PATIENTS BY ERWIN LEAR, REMEDIOS SUNTAY, IRVING M. PALLIN, ALBERT E. CHIRON, HERBERT J. FISCH, AND
More informationJSLS. Analgesia Following Major Gynecological Laparoscopic Surgery - PCA versus Intermittent Intramuscular Injection
Analgesia Following Major Gynecological Laparoscopic Surgery - PCA versus Intermittent Intramuscular Injection David M. B. Rosen, Alan M. Lam, Mark A. Carlton, Gregory M. Cario, Lindsay McBride 3 JSLS
More informationVECURONIUM BROMIDE IN ANAESTHESIA FOR LAPAROSCOPIC STERILIZATION
Br. J. Anaesth. (1985), 57, 765-769 VECURONIUM BROMIDE IN ANAESTHESIA FOR LAPAROSCOPIC STERILIZATION J. E. CALDWELL, J. M. BRAIDWOOD AND D. S. SIMPSON Although artificial ventilation can be used to avoid
More informationSEDATION OF CHILDREN REQUIRING ARTIFICIAL VENTILATION USING AN INFUSION OF MIDAZOLAM
Br.J. Anaesth. (986), 8, 0-08 SEDATION OF CHILDREN REQUIRING ARTIFICIAL VENTILATION USING AN INFUSION OF MIDAZOLAM P. D. BOOKER, A. BEECHEY AND A. R. LLOYD-THOMAS Long-term intubation of the trachea and
More informationConscious sedation in children
Michael Sury FRCA PhD Matrix reference 2D06, 3A07, 3D00 Key points Effective sedation techniques are specific to the procedure. Conscious sedation in children can be time-consuming but may save anaesthesia
More informationPre-medication with controlled-release oxycodone in the management of postoperative pain after ambulatory laparoscopic gynaecological surgery
Page 1 of 5 Anaesthetics & Critical Care Pre-medication with controlled-release oxycodone in the management of postoperative pain after ambulatory laparoscopic gynaecological surgery B Lim 1, SY Thong
More informationA PRELIMINARY NOTE ON TEMPERATURE VARIATIONS DURING GENERAL ANAESTHESIA.
2OI A PRELIMINARY NOTE ON TEMPERATURE VARIATIONS DURING GENERAL ANAESTHESIA. By K. H. WATKINS, B.SC, (Manchester), and S. R. WILSON, M.SC, M.B., Ch.B. (Manchester), B.S. (London,) F.R.C.-S. (Edinburgh).,
More informationPOST-TETANIC COUNT AND INTENSE NEUROMUSCULAR BLOCKADE WITH VECURONIUM IN CHILDREN
Br. J. Anaesth. (988), 6, 55-556 POST-TETANIC COUNT AND INTENSE NEUROMUSCULAR BLOCKADE WITH VECURONIUM IN CHILDREN S. A. RIDLEY AND N. BRAUDE Monitoring of profound neuromuscular blockade may be based
More informationMETABOLIC RESPONSE TO TOTAL HIP ARTHROPLASTY UNDER HYPOBARIC SUBARACHNOID OR GENERAL ANAESTHESIA
Br. J. Anaesth. (1987), 59, 725-729 METABOLIC RESPONSE TO TOTAL HIP ARTHROPLASTY UNDER HYPOBARIC SUBARACHNOID OR GENERAL ANAESTHESIA F. M. DAVIS, V. G. LAURENSON, J. LEWIS, J. E. WELLS AND W. J. GILLESPIE
More informationEFFECT OF ANXIETY ON GASTRIC EMPTYING IN PREOPERATIVE PATIENTS
Br. J. Anaesth. (1987), 59, 540-544 EFFECT OF ANXIETY ON GASTRIC EMPTYING IN PREOPERATIVE PATIENTS K. H. SIMPSON AND A. F. STAKES Pulmonary aspiration of gastric contents remains an important cause of
More informationOriginal Date of issue: 01/11/2005 Last Reviewed: 01/05/2011 Version:4 Page 1 of 7
Original Date of issue: 01/11/2005 Last eviewed: 01/05/2011 Version:4 Page 1 of 7 15: Anaesthesia 15.1 General anaesthesia 15.1.1 Intravenous anaesthesia Etomidate Injection (20mg/10ml) Ketamine Injection
More informationPAEDIATRIC GLUCOSE HOMEOSTASIS DURING ANAESTHESIA
British Journal of Anaesthesia 1990; 64: 413-418 PAEDIATRIC GLUCOSE HOMEOSTASIS DURING ANAESTHESIA C. S. T. AUN AND N. S. PANESAR SUMMARY The perioperative blood glucose regulatory response was compared
More informationUse of a mechanical simulator for training in applying cricoid pressure
British Journal of Anaesthesia 1996;77:468 472 Use of a mechanical simulator for training in applying cricoid pressure N. ASHURST, C. C. ROUT, D. A. ROCKE AND E. GOUWS Summary Using an airway management
More informationEVALUATION OF CONTINUOUS EPIDURAL TRAMADOL AND BUPIVACAINE COMBINATION FOR POSTOPERATIVE ANALGESIA+ S D'Souza* Prasanna A**#
Bahrain Medical Bulletin, Volume 18, Number 3, September 1996 EVALUATION OF CONTINUOUS EPIDURAL TRAMADOL AND BUPIVACAINE COMBINATION FOR POSTOPERATIVE ANALGESIA+ S D'Souza* Prasanna A**# Objectives: Determine
More informationMD (Anaesthesiology) Title (Plan of Thesis) (Session )
S.No. 1. Comparative Assessment of Sequential organ failure Assessment (SOFA) score and Multiple Organ Dysfunction Score (Mode) in Outcome Prediction among ICU Patients. 2. Comparison of Backpain after
More informationJMSCR Vol 05 Issue 06 Page June 2017
www.jmscr.igmpublication.org Impact Factor 5.84 Index Copernicus Value: 83.27 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: https://dx.doi.org/10.18535/jmscr/v5i6.125 Original Research Article Comparative
More informationNeostigmine as an adjunct to Bupivacaine, for caudal block in burned children, undergoing skin grafting of the lower extremities
Neostigmine as an adjunct to Bupivacaine, for caudal block in burned children, undergoing skin grafting of the lower extremities Dr. Pramod Gupta, Dr Amy Grace MD Department of Anaesthesiology and Critical
More informationSurgical Care at the District Hospital. EMERGENCY & ESSENTIAL SURGICAL CARE
Surgical Care at the District Hospital 1 14 Practical Anesthesia Key Points 2 14.1 General Anesthesia Have a clear plan before starting anesthesia Never use an unfamiliar anesthetic technique in an emergency
More informationCOMPARATIVE STUDY OF ORAL MIDAZOLAM, ORAL KETAMINE AND THEIR COMBINATION AS PREMEDICATION IN PEDIATRIC CARDIAC SURGERY
COMPARATIVE STUDY OF ORAL MIDAZOLAM, ORAL KETAMINE AND THEIR COMBINATION AS PREMEDICATION IN PEDIATRIC CARDIAC SURGERY Shah R.B 1, Patel R.D 1, Patel J.J 2, Mishra A.A 3, Thosani R.M 1. U N Mehta Institute
More informationThe use of Pudendal Nerve Block in Hemorrhoidectomy Operations: A Prospective Double Blind Placebo Control Study
Kasr El Aini Journal of Surgery VOL., 10, NO 3 September 2009 97 The use of Pudendal Nerve Block in Hemorrhoidectomy Operations: A Prospective Double Blind Placebo Control Study Sherif Adly and Mohamed
More informationCONCENTRATIONS OF DIETHYL ETHER IN THE BLOOD OF INTUBATED AND NON-INTUBATED PATIENTS
Brit. J. Anaesth. (1954), 26, 111. CONCENTRATIONS OF DIETHYL ETHER IN THE BLOOD OF INTUBATED AND NON-INTUBATED PATIENTS BY A. MACKENZIE, E. A. PASK AND J. G. ROBSON Medical School, King's College, and
More informationTHE FIRST YEAR'S EXPERIENCE OF AN ACUTE PAIN SERVICE
British Journal of Anaesthesia 1991; 67: 353-359 THE FIRST YEAR'S EXPERIENCE OF AN ACUTE PAIN SERVICE R. G. WHEATLEY, T. H. MADEJ, I. J. B. JACKSON AND D. HUNTER SUMMARY The benefits, risks and resource
More informationComparison Of 0.5%Bupivacaine And 0.5% Bupivacaine Plus Buprenorphine in Brachial Plexus Block
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 15, Issue 1 Ver. VIII (Jan. 2016), PP 01-08 www.iosrjournals.org Comparison Of 0.5%Bupivacaine And 0.5%
More information5 MUSCULOSKELETAL SYSTEM
5 MUSCULOSKELETAL SYSTEM 5.01 NON-STEROIDAL ANTIILAMMATORY DRUGS (NSAIDS) *Acetylsalicylic Acid (Aspirin) Tab Soluble 300mg Diclofenac Sodium Tab 25mg, Supp 25mg, 50mg & 100mg (Voltaren) 300-900mg every
More informationCOMPARATIVE ANAESTHETIC PROPERTIES OF VARIOUS LOCAL ANAESTHETIC AGENTS IN EXTRADURAL BLOCK FOR LABOUR
Br.J. Anaesth. (1977), 49, 75 COMPARATIVE ANAESTHETIC PROPERTIES OF VARIOUS LOCAL ANAESTHETIC AGENTS IN EXTRADURAL BLOCK FOR LABOUR D. G. LITTLEWOOD, D. B. SCOTT, J. WILSON AND B. G. COVINO SUMMARY Various
More informationMr David A McDonald Service Improvement Manager Whole System patient Flow Improvement Programme Scottish Government
Mr David A McDonald Service Improvement Manager Whole System patient Flow Improvement Programme Scottish Government Introduction Brief update Two main topics Use of Gabapentin Local Infiltration Analgesia
More informationTHE ANALGESIC PROPERTIES OF SUB-ANAESTHETIC DOSES OF ANAESTHETICS IN THE MOUSE
Brit. J. Pharmacol. (1964), 22, 596-63. THE ANALGESIC PROPERTIES OF SUB-ANAESTHETIC DOSES OF ANAESTHETICS IN THE MOUSE BY M. J. NEAL AND J. M. ROBSON From the Department of Pharmacology, Guy's Hospital
More informationA Protocol for the Analysis of Clinical Incidents September Incident Summary: failure to administer anaesthetic gas at start of operation
2. Incident Summary: failure to administer anaesthetic gas at start of operation Case Summary and Chronology Patient Mrs K (25) suffers from chronic arthritis. Over the years she has undergone many elective
More informationINTRAOCULAR PRESSURE CHANGES DURING RAPID SEQUENCE INDUCTION OF ANAESTHESIA: COMPARISON OF PROPOFOL AND THIOPENTONE IN COMBINATION WITH VECURONIUM
Br. J. Anaesth. (1988), 60, 379-383 INTRAOCULAR PRESSURE CHANGES DURING RAPID SEQUENCE INDUCTION OF ANAESTHESIA: COMPARISON OF PROPOFOL AND THIOPENTONE IN COMBINATION WITH VECURONIUM R. K. MIRAKHUR, W.
More informationPatient information. Nerve Blocks. Directorate of Anaesthesia PIF 1347 / V3
Patient information Nerve Blocks Directorate of Anaesthesia PIF 1347 / V3 What is a Nerve Block? This is an injection of local anaesthetic near to the nerves that go to the area of your operation, making
More informationCOMPARISON OF SUFENTANIL-OXYGEN AND FENTANYL-OXYGEN ANAESTHESIA FOR CORONARY ARTERY BYPASS GRAFTING
Br. J. Anaesth. (1988), 60, 530-535 COMPARISON OF SUFENTANIL-OXYGEN AND FENTANYL-OXYGEN ANAESTHESIA FOR CORONARY ARTERY BYPASS GRAFTING H. M. L. MATHEWS, G. FURNESS, I. W. CARSON, I. A. ORR, S. M. LYONS
More informationAssistant Professor, Anaesthesia Department, Govt. General Hospital / Guntur Medical College, Guntur, Andhra Pradesh, India.
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 15, Issue 8 Ver. I (August. 2016), PP 87-91 www.iosrjournals.org A Comparative Study of 0.25% Ropivacaine
More informationSedation in children and young people. Appendix J. Sedation for diagnostic and therapeutic procedures in children and young people
SEDATION IN CHILDREN AND YOUNG PEOPLE 1 Sedation in children and young people Sedation for diagnostic and therapeutic procedures in children and young people Appendix J 2 SEDATION IN CHILDREN AND YOUNG
More informationRecovery after day-case anaesthesia
Anaesthesia, 1990, Volume 45, pages 9 1 1-9 15 Recovery after day-case anaesthesia A 24-hour comparison of recovery after thiopentone or propofol anaesthesia P. J. HEATH, T. W. OGG AND W. R. GILKS Summary
More informationTHIS paper is written in an attempt to assess the value
Brit. J. Anccsth. (1953). 25, 244 INTRAVENOUS PETHIDINE IN ANESTHESIA By PHILIP WOLFERS St. George's Hospital, London THIS paper is written in an attempt to assess the value of intravenous pethidine as
More informationNew Methods for Analgesia Delivery
New Methods for Analgesia Delivery Guy Ludbrook MBBS PhD FANZCA Royal Adelaide Hospital and University of Adelaide South Australia Anesthesiology is on the verge of a major evolution that will involve
More informationIntravenous narcotics for premedication in outpatient anaesthesia
Acta Anaesthesiol Scand 1989: 33: 353-358 Intravenous narcotics for premedication in outpatient anaesthesia S. K. PANDIT and S. P. KOTHARY Department of Anesthesiology, University of Michigan Medical Center,
More informationJournal of Basic and Clinical Pharmacy. MIDAZOLAM PREMEDICATION IN ATTENUATING KETAMINE PSYCHIC SEQUELAE
MIDAZOLAM PREMEDICATION IN ATTENUATING KETAMINE PSYCHIC SEQUELAE S. C. Somashekara 1*, D. Govindadas 1, G. Devashankaraiah 1, Rajkishore Mahato 1, S. Deepalaxmi 2, V. Srinivas 3, J. V. Murugesh 3 and Devanand
More information(McQuay et al., 1980), to permit comparison of drug. Methods Ethical committee approval was obtained to perform
Br. J. clin. Pharmac. (1981), 12, 117-122 SUBLINGUAL BUPRENORPHINE USED POSTOPERATIVELY: CLINICAL OBSERVATIONS AND PRELIMINARY PHARMACOKINETIC ANALYSIS R.E.S. BULLINGHAM, H.J. McQUAY, D. DWYER, M.C. ALLEN
More informationNITROUS OXIDE-CURARE ANESTHESIA UNSUPPLEMENTED WITH CENTRAL DEPRESSANTS
Brit. J. Anasth. (1953). 25, 237 NITROUS OXIDE-CURARE ANESTHESIA UNSUPPLEMENTED WITH CENTRAL DEPRESSANTS By HENNING RUBEN The Finsen Institute, Copenhagen IN a previous communication (Ruben and Andreassen,
More informationBalanced Analgesia With NSAIDS and Coxibs. Raymond S. Sinatra MD, Ph.D
Balanced Analgesia With NSAIDS and Coxibs Raymond S. Sinatra MD, Ph.D Prostaglandins and Pain The primary noxious mediator released from damaged tissue is prostaglandin (PG) PG is responsible for nociceptor
More informationComparison of Ease of Insertion and Hemodynamic Response to Lma with Propofol and Thiopentone.
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 14, Issue 12 Ver. IV (Dec. 2015), PP 22-30 www.iosrjournals.org Comparison of Ease of Insertion and Hemodynamic
More informationResearch and Reviews: Journal of Medical and Health Sciences
Research and Reviews: Journal of Medical and Health Sciences Evaluation of Epidural Clonidine for Postoperative Pain Relief. Mukesh I Shukla, Ajay Rathod, Swathi N*, Jayesh Kamat, Pramod Sarwa, and Vishal
More informationEffect of transdermal hyoscine on nausea and vomiting during and after middle ear surgery under local anaesthesia
British Journal of Anaesthesia 1996; 76: 49 53 Effect of transdermal hyoscine on nausea and vomiting during and after middle ear surgery under local anaesthesia P. HONKAVAARA Summary The efficacy of transdermal
More informationORAL CLONIDINE PRE MEDICATION FOR ATTENUATION OF HAEMODYNAMIC RESPONSE TO LARYNGOSCOPY AND INTUBATION.
IJA No. A49/2k 12-3-2000 Indian 124 J. Anaesth. 2002; 46 (2) : 124-129 INDIAN JOURNAL OF ANAESTHESIA, APRIL 2002 124 ORAL CLONIDINE PRE MEDICATION FOR ATTENUATION OF HAEMODYNAMIC RESPONSE TO LARYNGOSCOPY
More informationEfficacy and Safety of Sublingual Sufentanil 30 mcg for the Management of Acute Pain Following Ambulatory Surgery. Pamela P.
Efficacy and Safety of Sublingual Sufentanil 30 mcg for the Management of Acute Pain Following Ambulatory Surgery Pamela P. Palmer, MD, PhD Disclosures for Dr. Pamela Palmer AcelRx employee Currently own
More informationCommunity Paediatric Policy for minimal sedation
Community Paediatric Policy for minimal sedation Classification: Policy Lead Author: Amy Wilson Consultant Community Paediatrician Additional author(s): Trust Sedation Comittee Authors Division: Salford
More informationOral Preanesthetic Medication In Children: A Comparison of Midazolam Syrup Versus Midazolam Syrup Plus Fentanyl Lozenge.
13 Oral Preanesthetic Medication In Children: A Comparison of Midazolam Syrup Versus Midazolam Syrup Plus Fentanyl Lozenge. Tarek Atef Tawfic MD Lecturer of anesthesia, faculty of medicine, Alexandria
More informationSafety and Effectiveness of Intravenous Morphine for Episodic Breakthrough Pain in Patients Receiving Transdermal Buprenorphine
Vol. 32 No. 2 August 2006 Journal of Pain and Symptom Management 175 Original Article Safety and Effectiveness of Intravenous Morphine for Episodic Breakthrough Pain in Patients Receiving Transdermal Buprenorphine
More informationEFFECT OF HALOTHANE, ENFLURANE AND ISOFLURANE ON BODY TEMPERATURE DURING AND AFTER SURGERY
Br. J. Anaesth. (1989), 6, 409-414 EFFECT OF HALOTHANE, ENFLURANE AND SOFLURANE ON BODY TEMPERATURE DURNG AND AFTER SURGERY V. RAMACHANDRA, C. MOORE, N. KAUR AND F. CARL Heat loss occurs during anaesthesia
More informationA comparison of fentanyl, sufentanil, and remifentanil for fast-track cardiac anesthesia Engoren M, Luther G, Fenn-Buderer N
A comparison of fentanyl, sufentanil, and remifentanil for fast-track cardiac anesthesia Engoren M, Luther G, Fenn-Buderer N Record Status This is a critical abstract of an economic evaluation that meets
More informationEffect of Ketorolac on Pain Scores and Length of Stay in Post Anaesthetic Care Unit after Major Abdominal Surgery
Effect of Ketorolac on Pain Scores and Length of Stay in Post Anaesthetic Care Unit after Major Abdominal Surgery Amanat Khan, Ghulam Sabir Iqbal, Azra Naseem, Mohammad Usman Ahmed, Omer Salahuddin Department
More informationEffect of preoperative oral amantadine on intraoperative anesthetic and analgesic requirements in female patients during abdominoplasty
Egyptian Journal of Anaesthesia (2013) 29, 7 11 Egyptian Society of Anesthesiologists Egyptian Journal of Anaesthesia www.elsevier.com/locate/egja www.sciencedirect.com Research Article Effect of preoperative
More informationPAIN Pharmacokinetics of controlled release morphine (MST) in patients with liver carcinoma
British Journal of Anaesthesia 94 (1): 95 9 (2005) doi:10.1093/bja/aei007 Advance Access publication October 29, 2004 PAIN Pharmacokinetics of controlled release morphine (MST) in patients with liver carcinoma
More informationFor patients and their carers this means smoother symptom control, better support in a crisis, and avoidance of admission if that is their choice.
Bedfordshire Palliative Care Palliative Care Medicines Guidance This folder has been produced to support professionals providing palliative care in any setting. Its aim is to make best practice in palliative
More informationThe effects of co-administration of benzhexol on the peripheral pharmacokinetics of oral levodopa in young volunteers
Br J Clin Pharmacol 1996; 41: 331 337 The effects of co-administration of benzhexol on the peripheral pharmacokinetics of oral levodopa in young volunteers J. ROBERTS, D. G. WALLER, A. G. RENWICK, N. O
More informationMORPHINE ADMINISTRATION
Introduction Individualised Administration Drug of Choice Route of Administration & Doses Monitoring of Neonates & high risk patients Team Management Responsibility Morphine Protocol Flow Chart Introduction
More informationTHE ANALGESIC EFFECT OF HALOTHANE
Brit. J. Anaesth. (1973), 45, 1105 THE ANALGESIC EFFECT OF HALOTHANE I. T. HOUGHTOH, M. CRONIN, P. A. REDFERN AND J. E. UTTING SUMMARY The effect of halothane on experimental ischaemic muscle pain has
More informationSYNOPSIS. Risperidone-R064766: Clinical Study Report RIS-INT-24 (FOR NATIONAL AUTHORITY USE ONLY)
SYNOPSIS Protocol No.: RIS-INT-24 Psychosis in Alzheimer s disease (PAD) analysis Title of Study: Risperidone in the treatment of behavioral disturbances in demented patients: an international, multicenter,
More informationCOMPARISON OF DIAZEPAM WITH MIDAZOLAM AS I.V. SEDATION FOR OUTPATIENT GASTROSCOPY
Br. J. Anaesth. (989), 63, 7-73 COMPARISON OF DIAZEPAM WITH MIDAZOLAM AS I.V. SEDATION FOR OUTPATIENT GASTROSCOPY L. D. SANDERS, J. DAVIES-EVANS, M. ROSEN AND J. O. ROBINSON Day-case sedation should be
More informationAnaesthetic Plan And The Practical Conduct Of Anaesthesia. Dr.S.Vashisht Hillingdon Hospital
Anaesthetic Plan And The Practical Conduct Of Anaesthesia Dr.S.Vashisht Hillingdon Hospital Anaesthetic Plan Is based on Age / physiological status of the patient (ASA) Co-morbid conditions that may be
More informationProblems in day care surgery
The Ulster Medical Journal, Volume 60, No. 2, pp. 176-182, October 199 1. Problems in day care surgery E M Thompson, H M L Mathews, D M McAuley Accepted 6 August 1991. SUMMARY In-patient admission represents
More information