European journal of anaesthesiology
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Randomized Controlled Trial Comparative Study Clinical Trial
Continuous spinal anaesthesia versus single dosing. A comparative study.
Continuous and single dose spinal anaesthesia were compared in a prospective randomized fashion in 108 patients undergoing orthopaedic surgery. Continuous spinal anaesthesia was via a 20 gauge polyamide multiperforated catheter introduced through an 18 gauge Tuohy needle. Single-dose spinal anaesthesia was performed with a 24 guage x 103 mm Sprotte spinal needle. ⋯ Hypotension was more frequent in those receiving single doses (P < 0.05). Caudal rotation of the outlet needle orifice to advance the catheter correlated with inadequate analgesia (P < 0.01, r = 0.38). There were no significant differences in the incidence of post-operative complications.
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A new technique of sciatic nerve block in the popliteal fossa was evaluated in 120 patients using an 18 s.w.g. cannula. Precise placement of the cannula was facilitated with the aid of a nerve stimulator. In addition to an initial dose of 1% prilocaine with adrenaline 1: 200,000 (5 mg kg-1), 5 mL 0.5% bupivacaine was used for blockade of the saphenous nerve distal to the medial tibial condyle. ⋯ Satisfactory anaesthesia was achieved in 117 patients (97.5%); two patients required general anaesthesia, since repositioning of the cannula after initial application of local anaesthetic was strictly avoided. No post-operative complications relating to the nerve block were observed. This technique of sciatic nerve block in the popliteal fossa provides effective and safe anaesthesia of the lower leg.
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The airway was managed successfully in two cases of difficult intubation using the Combitube, a new device for emergency intubation, which combines the functions of an oesophageal obturator airway and a conventional endotracheal airway. One patient could not be intubated due to lockjaw; in the other patient, the vocal cords could not be seen because of continued vomiting. The cases illustrate the benefit of the Combitube during emergency intubation for different problems and its effectiveness as an alternative to traditional intubation techniques.
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The cellular and synaptic mechanisms that underpin the state of general anaesthesia are discussed. Anaesthetics act principally on synaptic processes and this provides a satisfactory basis for understanding their effects on neural networks. ⋯ Effects on action potential firing patterns also play a role in anaesthetic modulation of neuronal signalling. Many of these complex data can be explained in terms of altered ion channel function.