Search PubMed⌕ Search

Biomedical subjects

K R Milligan

Publications and source records attributed to K R Milligan.

At least 37 records · Page 2Linked to original sources
PubMed1995

Effect of nebulized lignocaine on airway irritation and haemodynamic changes during induction of anaesthesia with desflurane.

This study was designed to assess the effect of nebulized lignocaine or saline given before induction on the quality of induction of anaesthesia with desflurane in unpremedicated, young, adult males. Of the first six patients, five developed laryngospasm, breath-holding, coughing and increased secretions. In four patients oxygen saturation decreased to 92% or less. Significant tachycardia and hypertension occurred in four patients, and bradyarrhythmia after induction occurred in three patients. Hiccups and bronchospasm occurred in one patient. Because of the unacceptably high incidence of complications, the study was discontinued. The incidence and severity of complications were not decreased by administration of nebulized lignocaine and were higher than those reported by other workers. We conclude that in unpremedicated, young, adult males, induction of anaesthesia with desflurane and nitrous oxide in oxygen was associated with a high incidence of respiratory irritant effects, tachycardia, hypertension and post-induction bradyarrhythmia. We also found that lignocaine, as used in this study, did not appear to obtund the cardiovascular and respiratory complications during inhalation induction using desflurane.

Adult↗
PubMed1995

Postoperative analgesia after co-administration of clonidine and morphine by the intrathecal route in patients undergoing hip replacement.

Postoperative analgesia after intrathecal co-administration of clonidine hydrochloride (75 micrograms) and morphine sulfate (0.5 mg) was compared with analgesia produced after either intrathecal morphine (0.5 mg) or 0.9% sodium chloride in 90 patients undergoing total hip replacement under bupivacaine spinal anesthesia. Patient-controlled morphine requirements were significantly reduced (P < 0.001) postoperation by both clonidine/morphine (median 5 mg/24 h) and morphine (median 7 mg/24 h) compared with control (saline) (median 28 mg/24 h). However, no significant additional reduction in postoperative analgesic requirements was shown with the clonidine/morphine combination compared with morphine alone. Visual analog pain scores, although good in all groups at all times, were significantly poorer in the control group at 2 h (P < 0.04) and 4 h (P < 0.001) after operation compared with both treatment groups, and significantly poorer than the clonidine/morphine group at 6 h (P < 0.002) and 24 h (P < 0.009) postoperation. Mean arterial blood pressure was significantly lower in the clonidine/morphine group than in the two other groups (P < 0.001) between 2 and 5 h after operation. The incidence of emesis was similar in the clonidine/morphine and morphine groups and was significantly more than in the control group.

Aged↗
PubMed1995

Analgesia following day-case knee arthroscopy--the effect of piroxicam with or without bupivacaine infiltration.

Sixty patients presenting for day-case arthroscopy of the knee under general anaesthesia were studied. Patients were randomly allocated to receive, in addition to intramuscular piroxicam 20 mg, either bupivacaine 0.25% 20 ml applied locally to the knee at the end of the procedure (n = 30) or no further intra-operative analgesia (n = 30). Visual analogue pain scores were significantly lower at 1, 2 and 4 h postoperatively in the bupivacaine group (p < 0.05). A higher proportion of patients in the piroxicam-only group required supplemental analgesia before discharge from hospital. The combination of piroxicam and bupivacaine provided superior analgesia to piroxicam alone.

Adult↗
PubMed1995

Intramuscular ketorolac following total hip replacement with spinal anaesthesia and intrathecal morphine.

We have studied the analgesic and morphine sparing effect of ketorolac tromethamine in 60 patients after total hip replacement under spinal anesthesia. In this double blind study 30 patients received ketorolac 30 mg IM 6 hourly postoperatively and the control group received saline. Analgesia was assessed by visual analogue pain scores (VAS) and morphine consumption by patient controlled analgesia (PCA). There was a significantly (P < 0.02) lower morphine consumption in the ketorolac group (7.1 +/- 8.6 mg; Mean +/- s.d.) when compared to the saline group (14.2 +/- 13.6 mg). Although there was a trend for lower VAS on the first postoperative night this was only significant at 10 hours postoperatively and the next morning at 08:00 hr. The incidence of side effects (emetic sequelae, pruritus and headache) were similar in both groups. It is concluded that ketorolac reduces the consumption of additional morphine in conjunction with intrathecal morphine but had no effects on the side effects.

Adult↗
PubMed1995

Postoperative analgesia following total hip replacement: a comparison of intrathecal morphine and diamorphine.

Sixty patients undergoing elective total hip replacement under spinal anaesthesia were randomly assigned to receive either intrathecal (IT) diamorphine 0.75 mg (n = 30) or IT morphine 1.0 mg (n = 30). Postoperative pain scores, analgesic requirements and side effects were assessed by a blinded observer. Postoperative pain scores were broadly similar and satisfactory for both groups but the amount of additional IV morphine required to achieve this was significantly reduced in the morphine compared with the diamorphine group (P < 0.05). Twelve of the morphine group required no postoperative analgesics compared with four in the diamorphine group (P < 0.02). There were no differences between the groups in the incidence of side effects such as emesis and pruritus. No significant postoperative respiratory depression was noted. In the doses used intrathecal morphine provided superior postoperative analgesia to that of intrathecal diamorphine.

Adult↗
PubMed1994

Co-administration of pethidine and clonidine: a spinal anaesthetic technique for total hip replacement.

Co-administration of pethidine 0.75 mg kg-1 and clonidine 75 micrograms intrathecally provided good intraoperative anaesthesia for total hip replacement, similar to that obtained using 0.5% isobaric bupivacaine. Sensory and motor block were of shorter duration than that after 0.5% isobaric bupivacaine and 0.5% isobaric bupivacaine with morphine 0.5 mg (P < 0.001 sensory block, P < 0.001 motor block). Postoperative morphine consumption, measured using a patient-controlled system, was similar to that in patients in the bupivacaine only group (pethidine-clonidine: median 39 mg/24 h; bupivacaine: median 34 mg/24 h) but greater than that in the bupivacaine-morphine group (median 8 mg/24 h) (P < 0.001). Visual analogue pain scores after operation were similar to those with bupivacaine alone at all but one of the recording times but were greater than those in patients who received bupivacaine and morphine at 4, 6 and 10 h after operation (P < 0.001, P < 0.04, P < 0.02). The combination did not offer any major advantage over conventional agents.

Adult↗
PubMed1994

Diclofenac sodium versus fentanyl for analgesia in laparoscopic sterilization.

The effectiveness of an anaesthetic technique employing diclofenac sodium as an analgesic given preoperatively by intramuscular injection was compared against one employing intravenous fentanyl in patients undergoing laparoscopic sterilization. Postoperative pain was marked and both drugs provided partial relief only. Patients in the diclofenac group had pain scores that were initially higher than those in the fentanyl group and the difference between the groups was statistically significant (P < 0.02). Patients in the diclofenac group who received postoperative supplemental morphine analgesia recorded lower pain scores at 30 min than comparable patients in the fentanyl group (P < 0.03). These findings suggest that neither drug provides sufficient analgesia for laparoscopic sterilization when given as a sole analgesic. Investigation of a combined analgesic technique employing morphine and a non-steroidal anti-inflammatory drug is warranted.

Adult↗
PubMed1993

The effect of patient position and obesity on the spread of epidural analgesia.

The aim of this study is to assess the effect of patient positioning and obesity on the height of block achieved during routine labor epidural analgesia. Forty patients weighing <80 kg were allocated to a control group and a further 40 weighing >100 kg to a study group. Half the patients in each group received an epidural injection in the lateral position, the remainder were in the sitting position. After insertion of an epidural catheter and injection of 12 ml of 0.25% bupivacaine plain the patients remained in position for a further 5 min. The height of block achieved, as assessed by loss of cold sensation, showed no difference between any of the groups. The results indicate that, for routine labor epidural analgesia, using 12 ml of 0.25% plain bupivacaine, neither patient positioning nor obesity affects the height of block achieved.

Journal Article↗
PubMed1993

Comparison of the analgesic effects of intrathecal clonidine and intrathecal morphine after spinal anaesthesia in patients undergoing total hip replacement.

We have studied the anaesthetic and analgesic properties of intrathecal clonidine and intrathecal morphine in patients undergoing total hip replacement under spinal anaesthesia. After routine spinal anaesthesia with 0.5% plain bupivacaine 2.75 ml, patients were allocated randomly to receive intrathecal clonidine, morphine or saline (control) as adjuvant to the bupivacaine. Postoperative analgesic effects were measured by consumption of morphine via patient-controlled analgesia and visual analogue pain scores. Both intrathecal clonidine and intrathecal morphine prolonged the time to first analgesia compared with saline (mean 278 (SD 93.2) min, 498 (282.4) min and 54 (61.9) min, respectively) (P < 0.001). Total morphine consumption on the first night after operation was significantly less in the intrathecal morphine group. There were no differences between the clonidine and the control group. Intrathecal clonidine prolonged the duration of spinal analgesia, but was markedly inferior to the intrathecal morphine in providing subsequent postoperative analgesia.

Adult↗
PubMed1993

A comparison of diclofenac and ketorolac for postoperative analgesia following day-case arthroscopy of the knee joint.

Seventy-one patients presenting for day-case arthroscopy were randomly allocated to receive either intramuscular diclofenac 75 mg or ketorolac 30 mg immediately after induction of anaesthesia. One hour after operation visual analogue pain scores were significantly lower in the ketorolac group compared with those receiving diclofenac. Pain scores at 2 and 4 h postoperatively were not significantly different between the two groups although six of those receiving diclofenac required opioid analgesia compared with only one in the ketorolac group. Discomfort in the operated knee was similar for both groups on the day following surgery, but pain from the intramuscular injection site was significantly greater in the diclofenac group. Intramuscular ketorolac 30 mg provided better postoperative analgesia and less pain at the injection site than diclofenac 75 mg.

Adolescent↗
PubMed1993

Intraoperative bupivacaine diminishes pain after lumbar discectomy. A randomised double-blind study.

A randomised double-blind study was carried out on 60 patients undergoing elective lumbar discectomy. Patients in the study group (n = 30) received an injection of 10 ml of 0.5% bupivacaine into the wound; the control group (n = 30) received none. Postoperative pain was measured by a visual analogue pain scale and by the amount of morphine administered by a patient-controlled analgesia system. Patients in the study group had lower pain scores, used less morphine, waited longer until their first demand for analgesia and reported their postoperative pain to be less severe.

Adult↗
PubMed1992

Extradural clonidine and bupivacaine for postoperative analgesia.

We have assessed the use of clonidine and bupivacaine for postoperative analgesia. Both drugs were administered via the extradural route, and were given both alone and in combination. The analgesia produced by clonidine was superior to that of bupivacaine; a combination of the drugs resulted in significantly better and longer duration of analgesia than each drug administered alone. Cardiovascular changes and the incidence of side effects were similar in all three groups. The sedative effects of clonidine were not marked.

Adult↗
PubMed1992

Extradural clonidine infusions for analgesia after total hip replacement.

We have examined the effectiveness of extradural clonidine infusions for postoperative analgesia and the effect of clonidine on extradural morphine. In a double-blind, controlled study, patients, undergoing total hip replacement were allocated randomly to receive one of two doses of extradural clonidine (25 micrograms h-1 or 50 micrograms h-1), low dose extradural morphine or a combination of morphine and clonidine. Pain scores in the morphine group were significantly greater than in the clonidine groups (P less than 0.01) and the combination group (P less than 0.05) during the first 1 h after surgery. The requirements for systemic analgesia were least in the combination and larger dose clonidine group, and the duration of effect of the initial bolus dose was significantly longer compared with the morphine and low dose clonidine groups (P less than 0.05). Arterial pressure was reduced in the clonidine groups, although the incidence of clinical hypotension was low. There were no significant differences between the groups in emetic symptoms or urinary retention.

Adult↗