European journal of anaesthesiology
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Randomized Controlled Trial
Effects of spinal anaesthesia versus epidural anaesthesia for caesarean section on postoperative analgesic consumption and postoperative pain.
Regional anaesthesia is commonly used for elective caesarean section. The aim of this study was to investigate whether there is a positive effect of either spinal or epidural anaesthesia on postoperative analgesic requirements and pain relief. ⋯ In parturients undergoing elective caesarean section, postoperative use of epidural ropivacaine via patient-controlled epidural analgesia is similar after spinal and epidural anaesthesia. Spinal anaesthesia is, however, accompanied with less postoperative pain, use of additional analgesics and side-effects.
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Randomized Controlled Trial
Randomised controlled trial of combined spinal epidural vs. spinal anaesthesia for elective caesarean section: vasopressor requirements and cardiovascular changes.
Combined spinal and epidural anaesthesia (CSEA) has previously been shown to result in a higher sensory block than equivalent single shot spinal anaesthesia (SSSA). In nonpregnant patients, hypotension was also more pronounced in the CSEA group. The aim of this randomized trial was to compare the haemodynamic stabilities of CSEA and SSSA during elective caesarean section when the same dose of anaesthetic was administered. This was studied directly by measuring the noninvasive arterial blood pressure (BP) and indirectly by the amount of ephedrine required to maintain baseline BP. Systemic vascular resistance index (SVRI) and cardiac index (CI) were also measured using thoracic impedance cardiography. ⋯ CSEA placement appears to offer no haemodynamic benefits compared with SSSA when the same dose of local anaesthetic is administered.
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Ultrasound can provide novel approaches to neural blockade independent of surface landmarks. We elucidated the sonoanatomy of the ulnar nerve in the forearm of healthy volunteers in order to identify an optimum site for neural blockade. ⋯ Our study demonstrates that ultrasound can be utilized to identify the ulnar nerve and artery in the forearm. This implies that traditional landmarks will not be required prior to neural blockade. We have suggested a point for blockade of the nerve to reduce risk of vascular puncture.
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In 2005, we developed and implemented the Emergency Anaesthetic Simulated Experience course at the Cheshire and Merseyside Simulation Centre.Emergency Anaesthetic Simulated Experience aims to teach clinical and team resource management skills to junior trainees in anaesthesia. Here we present 'proof-of-concept' in terms of long-term retention and transferability of acquired skills into subsequent clinical practice. ⋯ Team resource management skills learnt in a single educational intervention, based on simulated anaesthetic emergencies, are retained over the long term, translated into clinical practice and are transferable across the breadth of clinical activities.