PubMed Health⌕ Search

Biomedical subjects

D Buggy

Publications and source records attributed to D Buggy.

At least 19 recordsLinked to original sources
PubMed2004

Effect of intraoperative intravenous crystalloid infusion on postoperative nausea and vomiting after gynaecological laparoscopy: comparison of 30 and 10 ml kg(-1).

BACKGROUND: I.V. fluid administration has been shown to reduce postoperative nausea and vomiting (PONV). The optimum dose is unknown. We tested the hypothesis that administration of i.v. crystalloid of 30 ml kg(-1) would reduce the incidence of PONV compared with 10 ml kg(-1) of the same fluid. METHODS: A total of 141 ASA I female patients undergoing elective gynaecological laparoscopy were randomized, in double-blind fashion, to receive either 10 ml kg(-1) (n=71; CSL-10 group) or 30 ml kg(-1) (n=70; CSL-30 group) of i.v. compound sodium lactate (CSL). RESULTS: In the first 48 h after anaesthesia, the incidence of vomiting was lower in the CSL-30 group than in the CSL-10 group (8.6% vs 25.7%, P=0.01). Anti-emetic use was less in the CSL-30 group at 0.5 h (2.9% vs 14.3%, P=0.04). The incidence of severe nausea was significantly reduced in the treatment group at awakening (2.9% vs 15.7%, P=0.02), 2 h (0.0% vs 8.6%, P=0.04) and cumulatively (5.7% vs 27.1%, P=0.001). The numbers needed to treat to prevent vomiting, severe nausea and antiemetic use in the first 48 h were 6, 5 and 6, respectively. CONCLUSION: I.V. administration of CSL 30 ml kg(-1) to healthy women undergoing day-case gynaecological laparoscopy reduced the incidence of vomiting, nausea and anti-emetic use when compared with CSL 10 ml kg(-1).

Adult↗
PubMed2003

Comparative study of analgesic efficacy and morphine-sparing effect of intramuscular dexketoprofen trometamol with ketoprofen or placebo after major orthopaedic surgery.

AIMS: Multimodal analgesia is thought to produce balanced and effective postoperative pain control. A combined therapy with nonsteroidal anti-inflammatory drugs (NSAIDs) and opiates could result in synergistic analgesia by acting through different mechanisms. Currently there are very few parenterally administered NSAIDs suitable for the immediate postoperative period. Therefore, this study was undertaken to assess the analgesic efficacy, relative potency, and safety of parenteral dexketoprofen trometamol following major orthopaedic surgery. METHODS: One hundred and seventy-two patients elected for prosthetic surgery, were randomized to receive two intramuscular injections (12 hourly) of either dexketoprofen 50 mg, ketoprofen 100 mg or placebo in a double-blind fashion. Postoperatively, the patient's pain was stabilized, then they were connected to a patient- controlled analgesia system (PCA) of morphine for 24 h (1 mg with 5 min lockout). RESULTS: The mean cumulative amount of morphine (CAM) used was of 39 mg in the dexketoprofen group and 45 mg in the ketoprofen group vs 64 mg in the placebo group. (Reduction in morphine use was approximately one-third between the active compounds compared with placebo (adjusted mean difference of -25 mg between dexketoprofen and placebo and -23 mg between ketoprofen and placebo. These differences were statistically significant: P </= 0.0003; 95% CI -35, -14. Pain-intensity scores were consistently lower with the active compounds, the lowest corresponded to the dexketoprofen-treated patients. Regarding sedation, there were statistically significant differences between the two active compounds and placebo only at the 2nd and 13th hours. Wound bleeding was specifically measured with no statistically significant differences found between all the groups. CONCLUSIONS: Intramuscular administration of dexketoprofen trometamol 50 mg has good analgesic efficacy both in terms of opioid-sparing effect and control of pain after major orthopaedic surgery.

Adolescent↗
PubMed1999

Tramadol or fentanyl analgesia for ambulatory knee arthroscopy.

In a double-blind, randomized, controlled study, 61 patients who received a standardized anaesthetic for day case arthroscopic knee surgery were studied. Group T (n = 31) received tramadol 1.5 mg kg-1, and group F (n = 30) received fentanyl 1.5 micrograms kg-1 at the induction of anaesthesia. All patients also received 20 mL of intra-articular bupivacaine 0.5% at the end of surgery. Assessments were made of pain at rest and on movement, analgesic requirements and side-effects at hourly intervals up to 6 h and by means of a postal questionnaire at 24 h and 48 h post-operatively. Group F had higher pain scores than group T at 4 h only [VAS 3.3 (1.6-5.5) vs. 2.4 (1-4), P = 0.039, respectively; median (interquartile range)]. There were no other significant differences between the groups in terms of pain scores, supplemental analgesic requirements or incidence of side-effects. We conclude that tramadol offers little benefit clinically compared with fentanyl when used at induction of anaesthesia for day case arthroscopic knee surgery. Further studies are indicated in patients with more severe pain to determine the role of tramadol in post-operative analgesia.

Adolescent↗
PubMed1998

Pre-emptive glycopyrrolate 0.2 mg and bradycardia during gynaecological laparoscopy with mivacurium.

In a prospective, randomized, double-blind, placebo-controlled trial, the effect of pre-emptive glycopyrrolate 0.2 mg given intravenously on the incidence of bradycardia in patients undergoing elective gynaecological laparoscopy with mivacurium neuromuscular blockade was investigated. Seven out of 32 (21.6%) control patients developed bradycardia (heart rate < 50 min-1), compared with 3 of 31 (9.6%) patients receiving glycopyrrolate (P = 0.4). Glycopyrrolate 0.2 mg, given immediately before induction in gynaecological laparoscopy with mivacurium, did not significantly reduce the incidence of intraoperative bradycardia.

Adult↗
PubMed1997

Clonidine at induction reduces shivering after general anaesthesia.

PURPOSE: Postanaesthetic shivering occurs in 5-65% of patients. In addition to causing discomfort, it is associated with deleterious consequences. Our objective was to investigate the effect of 150 micrograms clonidine, at induction of anaesthesia, on perioperative core and peripheral temperature, incidence of postanaesthetic shivering and patients' perception of cold. METHODS: Sixty ASA 1 or 2 patients scheduled for elective orthopaedic limb surgery were randomly allocated to group 1, who received 150 micrograms clonidine iv, or group 2, who received a saline bolus iv, before induction. In all patients, anaesthesia was induced with fentanyl and propofol and maintained by spontaneous respiration (via a laryngeal mask airway) of oxygen, nitrous oxide and enflurane. Core (nasopharyngeal) and peripheral (dorsal hand) temperatures were recorded at induction and 15-min intervals. Nurses, unaware of the treatment groups, recorded visible shivering in the recovery room. When cognitive function returned, patients were asked to grade their perception of cold on a 10 cm linear analogue scale, higher scores indicating heat discomfort. RESULTS: While core temperature decreased and peripheral temperature increased in both groups, there was no difference between the groups at any time. However, there was a lower incidence of shivering in the clonidine group (20% vs 66.7%, P < 0.001). Patients receiving clonidine felt warmer; thermal comfort score (median interquartile range) 5.9 (5.0-7.2) vs 5.0 (4.5-6.0), P < 0.05). CONCLUSION: Clonidine 150 g iv at induction of anaesthesia reduces the incidence of shivering and patients' subjective perception of cold on emergence from general anaesthesia.

Adolescent↗
PubMed1997

Prevention of spinal anesthesia-induced hypotension in the elderly: comparison between preanesthetic administration of crystalloids, colloids, and no prehydration.

The practice of routinely prehydrating patients by infusing a crystalloid or colloid solution (up to 1.0 L/70 kg) for prevention of spinal anesthesia-induced hypotension has been challenged recently, after several reports of failure to demonstrate its efficacy in young women. We compared the incidence and frequency of hypotension and vasopressor therapy after spinal anesthesia and no prehydration with crystalloid and colloid prehydration in elderly patients. Eighty-five ASA grade I or II patients (aged 60-89 yr) for elective total hip replacement were randomized to receive 500 mL crystalloid solution (Hartmanns, n = 29), 500 mL colloid (Haemaccel, n = 28), or no prehydration (n = 28) over 10 min prior to spinal anesthesia. Hypotension was defined as a 30% decrease from baseline systolic blood pressure (BP) or systolic < 90 mm Hg, and was treated with ephedrine 3-mg boluses. Although absolute systolic BP readings were significantly higher in the colloid group between 6 and 30 min (P < 0.05), the incidence of hypotension was not significantly different between the groups. The incidence of ephedrine use, incidence of nausea/vomiting, and median total dose of ephedrine were similar in all groups. We conclude that, in elderly patients undergoing elective procedures, withholding prehydration is not associated with any greater degree of hypotension or need for vasopressor therapy compared with crystalloid or colloid prehydration.

Aged↗
PubMed1997

Acute superior vena caval syndrome with airway obstruction following elective mediastinoscopy.

A 47-year-old female patient had a subclinical superior vena caval syndrome which developed into the 'full blown' acute condition when she was placed into the left lateral position after mediastinoscopy. She developed airway obstruction requiring urgent re-intubation and subsequent admission to the intensive care unit. This subclinical condition might have been suspected pre-operatively if closer attention had been paid to the history, physical examination and review of the computerised axial tomography scan: she had a history of intermittent dysponea, wheeze and cough which was worse on waking and improved as the day progressed, she had a positive Pemberton's sign and the computerised axial tomography scan showed that the lesion was encroaching on the superior vena cava.

Acute Disease↗
PubMed1995

The space blanket and shivering during extradural analgesia in labour.

The incidence of shivering in women during epidural analgesia in labour is up to 33%, and may be highly distressing. Its mechanism is unclear, but the most widely held theory is that it is thermogenic. Pharmacological suppression may adversely effect the foetus or induce maternal hypothermia, and although physical remedies such as direct heat application are effective, they are also expensive and cumbersome. We recently found that the space blanket, a simple aluminised metallic foil, used pre-emptively, reduces shivering after general anaesthesia. We investigated the effect of the space blanket on the incidence and intensity of shivering, axilliary skin temperature, and subjective perception of cold during epidural analgesia for labour in 50 women over a four-hour time frame. Patients were randomised into group 1, who were wrapped in a space blanket immediately after commencement of epidural analgesia with bupivacaine, and group 2 (matched controls). Shivering was defined as visible tremor of the head, neck, trunk or limbs as observed by the attending midwives. Twenty-nine percent of group 1 and 35% of group 2 shivered (not significant), but a reduction in shivering intensity was observed in group 1 (P < 0.05). There was no significant difference in skin temperatures in either group, and no significant temperature change within the groups. Both groups had similar thermal comfort scores throughout the study, which correlated poorly with the presence of shivering. We conclude that there is no benefit in application of the space blanket to reduce epidural-analgesia related shivering in labour, which may indicate a non-thermogenic mechanism for this phenomenon.

Adult↗
PubMed1994

Pre-emptive use of the space blanket reduces shivering after general anaesthesia.

We have investigated the role of aluminized metal foil (space blanket, UN 320), used pre-emptively, in post-anaesthetic shivering and patients' subjective perception of cold after general anaesthesia of short duration. Sixty-eight ASA I and II patients undergoing orthopaedic and plastic surgery on the peripheries were allocated randomly to two groups: those in group 1 were wrapped (not less than 60% of body surface area) in the space blanket before induction of anaesthesia. In group 2 patients had standard surgical draping. In all subjects, anaesthesia was induced with fentanyl and propofol, and maintained with nitrous oxide and enflurane in oxygen, after a laryngeal mask airway was positioned. Patients were asked to grade their perception of cold on a visual analogue scale, before induction and on recovery. Skin (dorsum of hand) and core (nasopharyngeal) temperatures were recorded at 15-min intervals. Occurrence of shivering and cold scores were recorded by blinded observers. Groups were similar in age and gender; duration of anaesthesia was also similar (mean 41.6 (SEM 4.8) vs 47.5 (3.3) min, respectively). The incidences of shivering were 15% and 63% in groups 1 and 2, respectively (P < 0.001). Cold scores were 2.4 (0.4) and 5.7 (0.5), respectively (P < 0.001). Skin temperatures increased with increasing duration of anaesthesia in both groups but were greater at 15, 30 and 45 min in group 1 (33.38 (0.25) vs 31.56 (0.31), 34.46 (0.25) vs 32.45 (0.31) and 35.22 (0.36) vs 33.13 (0.34), respectively; P < 0.001 each comparison). Core temperature increased slightly in group 1 and decreased in group 2 (P = 0.11).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Posterior column sensory impairment during ambulatory extradural analgesia in labour.

Ambulatory or "walking" extradural analgesia in labour has recently gained popularity because of preservation of motor function and subjective somatic sensation in the lower limbs, resulting in increased maternal satisfaction. This is produced by combining dilute concentrations (e.g. 0.1%) of bupivacaine with opioids. Detailed clinical neurological examination after mobile extradural analgesia has not been reported. We have investigated the effect of 0.1% bupivacaine 15 ml and fentanyl 2 micrograms ml-1 on motor and sensory function in the lower limbs in 50 primigravidae requesting extradural analgesia in labour. This was performed before and 30 min after confirming placement of a lumbar extradural catheter. While power, co-ordination and reflexes in all lower limb muscle groups remained within normal limits, 66% (n = 33) developed abnormal distal proprioception, 44% (n = 22) had a positive Romberg's sign and 38% (n = 19) had altered vibration sense. Moreover, 44% (n = 22) said that their legs felt different on standing and they did not feel confident walking unaccompanied. However, this subjective perception correlated poorly with the presence of posterior column sensory signs. Although there was a reduction in pain scores on a visual analogue scale after 30 min (mean 8.85 (SEM 0.3) vs 3.06 (0.32); P < 0.0001), pain increased within 60 min (5.77 (0.45); P < 0.001).

Analgesia, Epidural↗