Biomedical subjects
I H Littlejohn
Publications and source records attributed to I H Littlejohn.
Post-operative pain relief in children following extraction of carious deciduous teeth under general anaesthesia: a comparison of nalbuphine and diclofenac.
In a randomized double-blind study 60 children, undergoing the extraction of carious deciduous teeth under day-case general anaesthesia, were assigned to receive either intravenous nalbuphine hydrochloride 0.3 mg kg-1 (n = 21), one or more diclofenac suppositories 12.5 mg to a dose of 1-2 mg kg-1 (n = 19), or no analgesia (n = 20). The duration of anaesthesia was longer in the diclofenac group (9.6 min, SD 3.5) compared with control (7.2 min, SD 2.6) and nalbuphine (6.9 min, SD 3.0) groups respectively (P < 0.05). There were no statistically significant differences in post-operative pain scores during the 45 min post-operative period studied between the three groups using an objective pain score. We conclude that using this methodology we were unable to demonstrate any statistically significant differences between the analgesic effects of either intravenous (i.v.) nalbuphine or diclofenac suppositories compared with control.
Prediction of postoperative nausea and vomiting using a logistic regression model.
In a previous study, logistic regression analysis was used to determine the association of independent fixed patient factors with the incidence of postoperative nausea and vomiting (PONV). Female sex, previous history of PONV, use of postoperative opioids, previous history of motion sickness and an interaction between male sex and previous history of PONV were combined in an equation from which risk of PONV could be estimated. The present study was designed to test this equation in a group of patients with wide selection criteria. Data on 400 patients were collected in relation to pre-, per- and postoperative factors which may influence the incidence of PONV. The equation was used to predict PONV, and actual outcome was compared with that predicted. The overall incidence of PONV was 36%. The equation predicted an overall probability of PONV of 27.4%. If the model was used to define individual patients as predicted to have or not to have PONV, it was correct only 71% of the time. However, there was good agreement between the actual incidences of PONV and those predicted among the 16 risk groups created by the model.
Intubating conditions following 1R CIS, 1'R CIS atracurium (51W89). A comparison with atracurium.
51W89 besylate, a new intermediate acting non-depolarising muscle relaxant, consisting of a single stereo-isomer of the commercial preparation of atracurium has been assessed in respect of intubating conditions during nitrous oxide-propofol-isoflurane anaesthesia. Intubating conditions at 2 min were acceptable in 67% of patients following a dose of 0.1 mg.kg-1 and in 90% of patients following a dose of 0.15 mg.kg-1. Intubating conditions at 1.5 min were acceptable in 76% of patients following a dose of 0.2 mg.kg-1. In comparison, intubating conditions at 2 min were acceptable in 95% of patients following 0.5 mg.kg-1 of atracurium. The intubating conditions at 2 min following a dose of 0.1 mg.kg-1 51W89 besylate were significantly worse than the other three groups (p < 0.05); however, there was no significant differences between the scores in the other three groups. There was no clinical evidence of histamine release in the groups receiving 51W89 besylate compared to two out of the 19 patients who had cutaneous flushing following the administration of atracurium. Our results suggest that 51W89 besylate provides acceptable intubating conditions at 2 min following a dose of 0.15 mg.kg-1 and may prove to be an acceptable alternative to atracurium if studies in progress confirm its greater cardiovascular stability and reduced propensity to release histamine than its parent compound.
Nitrous oxide and laryngeal mask cuff pressure.
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