Lancet
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Comparative Study
Anaesthetic morbidity following caesarean section under epidural or general anaesthesia.
To find out whether morbidity in the first postoperative week is affected by type of anaesthetic technique, healthy patients who had caesarean sections under epidural anaesthesia were compared with those who were given a general anaesthetic. Epidural anaesthesia was associated with less pain (p less than 0.00001) and discomfort in the immediate postoperative period. ⋯ Fewer mothers were coughing (p less than 0.005), had fever (p less than 0.01), or felt tired and depressed (p less than 0.005) by the sixth postoperative day after epidural caesarean section. The epidemiology of anaesthetic morbidity needs to be assessed in other surgical patients.
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25 consecutive episodes of acute chest syndrome in 13 adult patients with sickle-cell disease were studied retrospectively. Chest symptoms were present on admission in 23 of 25 episodes. Abnormal chest signs and an abnormal chest X-ray were present on admission in only 11 and 9 episodes, respectively, but developed later in the remainder. ⋯ In 12 episodes (6 bilateral, 6 unilateral) exchange transfusion was required and produced striking improvement in 11. Despite intensive microbiological investigation, infection was found in only 2 episodes--1 mycoplasma and 1 evidence of Escherichia coli. Pulmonary intravascular sickling may account for much of the clinical picture.
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Randomized Controlled Trial Clinical Trial
Pancuronium prevents pneumothoraces in ventilated premature babies who actively expire against positive pressure inflation.
Preterm infants who were making expiratory efforts against ventilator inflation were randomised to be paralysed with pancuronium or to receive no paralysing agent during ventilation. Pneumothoraces developed in all 11 unparalysed babies but in only 1 of 11 (p less than 0.0004) of those managed with pancuronium, which had no serious side-effects. In 34 infants excluded from the trial because they were not breathing against the ventilator, no pneumothoraces developed.