European journal of anaesthesiology
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Case Reports Comparative Study
A patient's experience of a new post-operative patient-controlled analgesic technique.
A patient underwent major spinal surgery, twice within a 3 week period. On the first occasion his post-operative pain was managed by conventional morphine patient-controlled analgesia (PCA). ⋯ The results showed comparable quality of analgesia and sedation and similar effects on respiration. However, the patient expressed a preference for morphine PCA.
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Randomized Controlled Trial Clinical Trial
Preferential channelling of anaesthetic solution injected within the perivascular axillary sheath.
Preferential channelling of anaesthetic solution injected into the perivascular axillary sheath was investigated in 40 patients undergoing elective orthopaedic upper-limb surgery. Three needles, with different approaches and inclinations, were inserted near the three main terminal branches of the brachial plexus using an axillary approach. ⋯ Back flow was observed, mainly in the needle nearest to the radial nerve during injection of the anaesthetic solution in the superior and inferior aspects of the brachial artery, and in the needle close to the ulnar nerve when the injection was performed posterior to the artery, near the radial nerve. These results could be related to the trapping of anaesthetic solution in unconnected compartments and to the slope of the needle injecting the anaesthetic solution which spreads preferentially along a gradient following the needle shaft direction.
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Randomized Controlled Trial Clinical Trial
Double burst stimulation with submaximal current.
The present study evaluated responses to double burst stimulation (DBS) at supramaximal and submaximal currents in 30 adult patients. Usually, DBS is applied with supramaximal stimulation, but this may be quite uncomfortable for the awake patient. Therefore, the authors investigated whether it is possible to obtain an accurate assessment of significant residual neuromuscular blockade if the stimulus current is reduced to 30 mA. ⋯ The relations between control T4/T1 ratios determined by supramaximal TOF stimulation and D2/D1 ratios determined by supramaximal DBS3.3 and submaximal DBS3.3 were Y = 0.99X + 0.08 and Y = 1.01X + 0.04, respectively, and there was no statistical difference between the two regression lines. The same relation between T4/T1 ratios and D2/D1 ratios by DBS3.2 were Y = 0.69X + 0.05 and Y = 0.72X + 0.02, respectively, and there was no significant difference. It is concluded that evaluation of the response to DBS at 30 mA has the same reliability as evaluation with supramaximal current.
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Case Reports Comparative Study
Anaesthesia for electroconvulsive therapy: use of propofol revisited.
In three clinically depressed patients undergoing repeated electroconvulsive therapy (ECT) with either propofol or methohexitone, dose-dependent decreases in the duration of motor and EEG seizure activity were noted. Use of a 'minimally' hypnotic dose of propofol (0.75-1.0 mg kg-1) was associated with a seizure duration which was comparable to standard hypnotic doses of methohexitone. We conclude that doses of propofol < 1.5 mg kg-1 are associated with a clinically acceptable duration of EEG seizure activity (> 30 s) during ECT.
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Randomized Controlled Trial Clinical Trial
Airway management in dental anaesthesia.
Ninety patients were allocated randomly to three groups for airway maintenance during paediatric outpatient dental extraction: laryngeal mask airway, nasal mask with nasopharyngeal airway, or nasal mask alone. Surgical access was better with the laryngeal mask. ⋯ No patient became hypoxic with the laryngeal mask, five patients became hypoxic with the nasal mask and two with the nasopharyngeal airway at corresponding periods, although the differences were not statistically significant. The laryngeal mask airway is recommended for paediatric outpatient dental anaesthesia.