Anaesthesia and intensive care
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Anaesth Intensive Care · Nov 1989
Comparative StudyA controlled oximetric evaluation of inhalational, opioid and epidural analgesia in labour.
The effects on patient oxygenation of nitrous oxide, narcotic and epidural analgesia in labour were evaluated using pulse oximetry. Five groups of ten patients received either no analgesia (Control, Group 1), an epidural block alone (Group 2), nitrous oxide in oxygen alone (Group 3), intramuscular pethidine (Group 4), or nitrous oxide in oxygen combined with intramuscular pethidine (Group 5). Derived parameters included the maximum (MAX), minimum (MIN), average maximum (AV MAX), and average minimum (AV MIN) arterial haemoglobin oxygen saturation (SaO2), and differences between maxima and minima (MAX-MIN). ⋯ All other groups showed no significant difference in any parameter when compared with the control group. The results are discussed with reference to normal and disordered maternal physiological changes in pregnancy. It is suggested that nitrous oxide should not be used for analgesia in labour where there is concern about maternal, placental or foetal reserve.
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Anaesth Intensive Care · Nov 1989
A prospective survey of anaesthetic critical events in a teaching hospital.
A survey of anaesthetic critical events based on voluntary anonymous reports was undertaken over a two and a half year period within a teaching hospital Department of Anaesthesia. At the end of the survey 167 reports were analysed. Human error was a contributing factor in 82% of events. ⋯ The method enables the collection of objective data on factors contributing to anaesthetic and surgical risk and the formulation and evaluation of potential corrective strategies. It also facilitates harmonious peer review via individual and group feedback activities. The adoption of such a survey on a wider scale is seen as a valuable part of quality assurance in the continuing attempt to increase patient safety.
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Anaesth Intensive Care · Nov 1989
Comparative StudyA comparison of the effects of suxamethonium, atracurium and vecuronium on intracranial haemodynamics in swine.
Sixteen Yorkshire swine weighing 15-20 kg were studied to compare the effects of suxamethonium, atracurium and vecuronium on intracranial pressure (ICP), heart rate (HR), arterial blood pressure (BP), and cerebral perfusion pressure (CPP) in swine with normal or elevated ICP. In each animal an intracranial pressure-volume curve was produced by the inflation of an epidural balloon. The baseline ICP (Po), the ICP at the inflection point (Pi) and on the steep portion (Pmax) of the pressure-volume curve were identified and the balloon volumes recorded. ⋯ Suxamethonium produced an early fall in ICP (0.8 +/- 0.3, 2.6 +/- 1.0 and 3.5 +/- 1.3 mmHg at Po, Pi and Pmax respectively: P = .0005) followed by a rapid rise above the pre-infusion level (1.8 +/- 0.6, 2.8 +/- 0.6 mmHg, and 2.2 +/- 0.5 mmHg at Po, Pi and Pmax respectively: P = .0005). A fall in BP coupled with the rise in ICP resulted in a fall in CPP (5.8 +/- 2.3, 6.1 +/- 1.2, and 6.3 +/- 1.8 mmHg at Po, Pi and Pmax respectively: P = .0005). Although the fall in CPP was not large, in the presence of elevated ICP, where CPP already is marginal, such a decrease may compromise cerebral blood flow.(ABSTRACT TRUNCATED AT 250 WORDS)
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Anaesth Intensive Care · Nov 1989
Randomized Controlled Trial Comparative Study Clinical TrialPost-cholecystectomy pulmonary function following interpleural bupivacaine and intramuscular pethidine.
Twenty-four patients who were to undergo cholecystectomy were randomised into two groups, one to receive postoperative analgesia with interpleural bupivacaine, 20 ml of a 0.5% solution with adrenaline 5 micrograms/ml, and the other to receive intramuscular pethidine, 1 mg/kg. Preoperative and postoperative pulmonary function, postoperative pain scores, and days from operation to hospital discharge were recorded and statistically compared. There was no significant difference in pain scores, nor in days to discharge; however, postoperative pulmonary mechanics were significantly poorer in the interpleural group. A hypothesis to explain the differences is offered.