RESUMEN
This study compared the effectiveness and side-effects of intra-operative fentanyl with fentanyl and morphine for elective adenotonsillectomy in a double-blind study, in 60 children randomly allocated to receive either intravenous fentanyl 1 microg x kg(-1) intra-operatively or intramuscular morphine 100 microg x kg(-1) at induction. All children received a standard anaesthetic induction with intravenous fentanyl 1 microg x kg(-1) and propofol 4-5 mg x kg(-1) and maintenance with oxygen, nitrous oxide and isoflurane. Pain scores, emetic episodes and supplemental morphine requirements were recorded for 24 h postoperatively. The overall incidence of postoperative vomiting was high in both groups: 70% in the fentanyl group and 78% in the morphine group. The incidence of postoperative vomiting was lower in the fentanyl group (p < 0.03) in the first 4 h, but similar by 24 h. Children who received morphine at any time in the first 24 h had more median (range) episodes of vomiting [2 (0-7)] than children receiving fentanyl only [l (0-3); p < 0.03]. Administration of rescue anti-emetics, pain scores in recovery and pain scores over the next 24 h were similar between the two groups.
Asunto(s)
Adenoidectomía , Analgésicos Opioides/uso terapéutico , Fentanilo/uso terapéutico , Morfina/uso terapéutico , Dolor Postoperatorio/prevención & control , Tonsilectomía , Adolescente , Analgésicos Opioides/efectos adversos , Antieméticos/uso terapéutico , Niño , Preescolar , Método Doble Ciego , Femenino , Fentanilo/efectos adversos , Humanos , Masculino , Morfina/efectos adversos , Dimensión del Dolor/métodos , Náusea y Vómito Posoperatorios/inducido químicamenteRESUMEN
PURPOSE: To compare the laryngeal mask airway (LMA) insertion conditions produced by propofol and a thiopental - low dose atracurium combination. METHODS: In a randomized controlled double blind study, 120 premedicated patients were allocated into four groups. After pre-oxygenation, anesthesia was induced as follows: 1 microg x kg(-1) fentanyl, 2.5 mg x kg(-1) propofol (group I); 1 microg x kg(-1) fentanyl, 5 mg x kg(-1) thiopental (group II); 1 microg x kg(-1) fentanyl, 5 mg x kg(-1) thiopental, 0.05 mg x kg(-1) or 0.1 mg x kg(-1) atracurium (groups III and IV respectively). The LMA was inserted by a blinded anesthesiologist who also assessed the following insertion conditions on a three point scale; jaw relaxation, biting, gagging, coughing, presence of laryngospasm, adequacy of airway patency, number of attempts at insertion and overall insertion conditions. RESULTS: There was no difference in insertion conditions between groups I, III and IV. Group II produced the worst overall conditions (P<0.05). There were no differences in hemodynamic changes and apnea times between all four groups. CONCLUSION: The combination of fentanyl-thiopental with low dose atracurium (0.05 or 0.1 mg x kg(-1)) provided conditions comparable with those of propofol for LMA insertion.
Asunto(s)
Anestésicos Intravenosos/farmacología , Atracurio/farmacología , Máscaras Laríngeas , Fármacos Neuromusculares no Despolarizantes/farmacología , Propofol/farmacología , Tiopental/farmacología , Adulto , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
There is a belief prevalent in Western society that pregnancy is more stressful for first-time expectant couples. Few research studies have addressed this issue and the existing findings, on both men and women, are conflicting. The present investigation found higher psychological symptom levels in both members of second-time expectant couples in the third trimester; however, differences reached statistical significance only for men. Second-time couples tended to have lower emotional attachment to their unborn baby. The results are discussed in terms of the influence of parity on stresses arising both from the pregnancy experience and the environment.