European journal of anaesthesiology
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Randomized Controlled Trial Clinical Trial
Central nervous system symptoms after intravenous lignocaine: dose-response during pregnancy.
There is continuing controversy over what dose of what drug should be used to identify an accidental intravascular or subarachnoid catheter placement in obstetric epidural anaesthesia. The purpose of this randomized, double-blind study was to evaluate the dose-effect relationship for the production of central nervous system (CNS) symptoms by intravenous lignocaine. ⋯ An ED95 of 1.12 mg kg-1 was calculated to produce reliable CNS symptoms when injected intravascularly. Lignocaine is an effective and reliable marker for intravenous injection in pregnant women.
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Comparative Study
Intra-individual open comparison of burst-suppression-isoflurane-anaesthesia versus electroconvulsive therapy in the treatment of severe depression.
Isoflurane anaesthesia was proposed instead of electro-convulsive therapy (ECT) in patients with treatment-refractory depression. This open study compared burst-suppression-isoflurane-anaesthesia (BSIA) and ECT in 12 severely depressed patients. A series of 6 BSIA was administered in every patient. ⋯ BSIA requires more time and monitoring than ECT. Our exclusions of coronary, cerebral and peripheral vascular disease, untreated hypertension and focal neurological disease are strongly recommended. Due to the ease of application, ECT remains the standard treatment in depressed patients, but we consider BSIA a valuable alternative at least in patients who object to ECT.
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Case Reports
Thoracotomy wound exploration in a single lung transplant recipient under extrapleural paravertebral nerve blockade.
Instillation of bupivacaine through a catheter accurately placed in the extrapleural space prior to closure of a thoracotomy incision provides effective, reliable post-operative analgesia. Its usefulness for further surgery in the post-operative period, in this case wound exploration in a lung transplant recipient, is described.
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Simulation is often used for training personnel in activities where the consequences of inappropriate actions are serious. We report a realistic training simulator, which can reproduce practically all potential malfunctions in the anaesthetic machine. Using actual standard equipment (Dameca 10750), the interior of the anaesthetic machine has been profoundly modified, whereas the external appearance remains virtually unchanged. ⋯ While assisted by an instructor, the trainee performs hands-on interactive experimentation with the simulator, while being exposed to 'unexpected' machine faults, which prompt for interpretation of error symptoms. Alternatively, the trainee can personally activate the simulated symptoms of different component failures, to enhance learning of the functional principles of the apparatus. The latter approach also allows a systematic presentation of defects to be identified by each step in a formal safety checklist for anaesthetic machines.
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Randomized Controlled Trial Comparative Study Clinical Trial
Intubation with propofol: evaluation of pre-treatment with alfentanil or lignocaine.
The effect of lignocaine or alfentanil pre-treatment on conditions at orotracheal intubation following induction with propofol, but without the use of muscle relaxants, were compared in a prospective, controlled, double-blind study. Forty five healthy patients undergoing elective surgery were randomly allocated to receive either 0.9% saline (control), alfentanil 20 micrograms/kg-1, or lignocaine 1.5 mg kg-1 prior to induction with propofol 2.5 mg kg-1. ⋯ Intubation scores of 1 or 2 were obtained in 14 out of 15 patients (93%) in the alfentanil group and this was significantly better than the lignocaine group (33%) or control group (20%). No difference was detected between the scores of the latter two groups.