European journal of anaesthesiology
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Randomized Controlled Trial Comparative Study Clinical Trial
Cocaine or phenylephrine/lignocaine for nasal fibreoptic intubation?
In order to assess if a mixture of phenylephrine/lignocaine is as effective as cocaine for local analgesia and vasoconstriction during nasal fibreoptic intubation, 99 patients receiving topical nasal analgesia either with cocaine 10% or a mixture of phenylephrine 1% and lignocaine 4% were studied in a randomized double-blind investigation. After topical analgesia a flexible fibreoptic endoscope was advanced through a nostril. Larynx, glottis and trachea were endoscopically sprayed with lignocaine. ⋯ Blood pressure, heart rate and ECG-ST segment were determined before and after topical nasal analgesia, after induction of anaesthesia and after nasotracheal intubation. There were no significant differences in pain intensity of epistaxis between groups during endoscopy, nor significant alterations in haemodynamic parameters or ST-segment. It is concluded that the mixture of phenylephrine and lignocaine is a useful alternative to cocaine for local analgesia and vasoconstriction during nasal fibreoptic intubation.
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Randomized Controlled Trial Clinical Trial
The effect of intrathecal midazolam on post-operative pain.
Intrathecal midazolam for use as a post-operative analgesic when given alone and in conjunction with intrathecal diamorphine was assessed. Fifty-two patients scheduled for elective Caesarean section under spinal anaesthesia were randomly allocated to receive either bupivacaine (B), bupivacaine with diamorphine (BD), bupivacaine with midazolam (BM) or all three (BMD) by intrathecal injection. Post-operatively, no differences in visual analogue score (VAS), sedation or post-operative nausea and vomiting (PONV) could be demonstrated between groups. ⋯ No side effects attributable to midazolam were identified. Intrathecal midazolam at this dose appears safe and has clinically detectable analgesic properties. The duration of useful analgesia appears to be short-lived.
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Randomized Controlled Trial Clinical Trial
Maternal and fetal effects of adrenaline with bupivacaine (0.25%) for epidural analgesia during labour.
The use of adrenaline added to bupivacaine during epidural analgesia for labour is controversial. The effects of epidural analgesia with bupivacaine containing adrenaline on maternal blood pressure and heart rate, uterine activity, progress of labour, fetal heart rate and Apgar scores, were assessed using visual analogue pain scores, upper level of sensory block and motor blockade in 60 parturients who were allocated randomly to receive: 10 mL of bupivacaine 0.25% plain (group I) or with adrenaline 5 micrograms mL-1 (group II) or with adrenaline 1.66 micrograms mL-1 (group III). ⋯ It is concluded that adrenaline at 5 micrograms mL-1 significantly prolongs the first stage of labour. Neither adrenaline 5 micrograms mL-1 nor 1.66 micrograms mL-1 has any beneficial effect.
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Randomized Controlled Trial Clinical Trial
Volume replacement with gelatin or hydroxyethylstarch solutions does not impair somatosensory evoked potential monitoring: a haemodilution study in conscious volunteers.
The influence of haemodilution with colloids on somatosensory evoked potentials in non-premedicated volunteers is reported. In seven volunteers (randomized crossover design), blood (20 mL kg-1 within 30 min) was removed and simultaneously replaced by gelatin 3% or hydroxyethylstarch 6%. After 30 min, blood was retransfused within 30 min. ⋯ Retransfusion increased haematocrit to 34.4 +/- 0.9% (gelatin) and to 34.2 +/- 1.3% (hydroxyethylstarch). Neither haemodilution with gelatin nor haemodilution with hydroxyethylstarch or retransfusion influenced evoked potentials. In conclusion, the treatment of blood loss up to 30% of estimated blood volume with gelatin or hydroxyethylstarch will not affect somatosensory evoked potential monitoring provided normovolaemic conditions are maintained.
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The facial nerve is monitored intra-operatively using electromyography to identify and prevent damage during the excision of an acoustic neurinoma. In order to determine whether a profound level of peripheral neuromuscular blockade could be achieved without compromising facial electromyographic monitoring, 11 patients undergoing resection of acoustic neurinoma were studied. ⋯ The facial nerve was directly stimulated in the surgical field and the facial evoked muscle potentials (EMPs) were recorded. Even under complete peripheral neuromuscular blockade (i.e. no electrically evoked muscle potential measurable over the hypothenar eminence, no palpable hypothenar muscle response) it was possible to evoke facial muscle electromyographic responses by stimulation of the facial nerve.