European journal of anaesthesiology
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Reports about post-operative infections associated with the use of propofol prompted us to investigate the in-use contamination of lipid-formulated intravenous (i.v.) anaesthetics used for general anaesthesia or for sedation of intensive care patients in this department. The level and incidence of extrinsic contamination of propofol ('Diprivan') and of another intravenous anaesthetic, etomidate, formulated in lipid solution ('Etomidat-lipuro') was found to be low during two study periods. However, the need to observe strict aseptic precautions in handling these intravenous drugs must be emphasized.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of metoclopramide and ondansetron for the prevention of nausea and vomiting after intrathecal morphine.
Nausea and vomiting remain unpleasant side effects of intrathecal (i.t.) morphine and of the numerous therapies tried, only prophylactic intravenous (i.v.) metoclopramide has been reported to be promising. Seventy-three patients, scheduled for orthopaedic prosthesis surgery of the hip or knee were studied. They received 4 mL of plain bupivacaine and 0.3 mg of preservative-free morphine i.t. for anaesthesia. ⋯ Incidences of severe vomiting were 24, 35 and 12% respectively. Eight patients in the saline group, seven in the metoclopramide and 10 in the ondansetron group did not need additional opioids for post-operative pain relief. We conclude that, metoclopramide and ondansetron were not better than saline in the prevention of post-operative emesis induced by intrathecal morphine.
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Randomized Controlled Trial Clinical Trial
Readiness for surgery after axillary block: single or multiple injection techniques.
We have assessed prospectively the time to readiness for surgery following axillary block (sum of block performance and latency times) in 80 patients. The brachial plexus was identified using a nerve stimulator, and anaesthetized with 45 mL of mepivacaine 1% with adrenaline 5 micrograms mL-1. In group 1 (single injection) the whole volume of mepivacaine was injected after locating only one of the plexus nerves. ⋯ The frequency of adverse effects (vessel puncture or paraesthesia) was similar in both groups. No neurological sequelae were observed. We conclude that the multiple injection technique takes longer to perform than single injection, but that readiness for surgery is faster because of shorter block latency and better spread of analgesia.
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Although the administration of alfentanil is routine in neurosurgical anaesthesia, the effects of the drug on cerebrospinal fluid pressure (CSFP) or intracranial pressure (ICP) have been a subject of controversy in the past. Therefore the effects of alfentanil (3 micrograms kg-1) on mean lumbar cerebrospinal fluid pressure (CSFP), heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP) and end-tidal carbon dioxide (ETCO2) in human volunteers without cerebral disease is reported here. The CSFP increased from 9 mmHg (P < 0.05) after intravenous (i.v.) injection of alfentanil, to 12 mmHg whereas MAP, CVP, HR and ETCO2 remained stable throughout the investigative period. The results from this study suggest that alfentanil, even when administered in low doses, leads to a relatively small but statistically significant increase in CSFP in humans with uncompromised intracranial compliance.
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Case Reports
Thoracic epidural anaesthesia and analgesia with bupivacaine for transsternal thymectomy for myasthenia gravis.
The present study describes the management of a myasthenic patient undergoing transsternal thymectomy for whom thoracic epidural anaesthesia using 15 mL of bupivacaine 0.5% combined with isoflurane 0.4% and nitrous oxide in oxygen 50% provided good intra-operative relaxation followed by an uneventful recovery and eliminated the need for other post-operative analgesics.