Anaesthesia and intensive care
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Anaesth Intensive Care · Nov 1990
Randomized Controlled Trial Comparative Study Clinical TrialThe addition of fentanyl to epidural bupivacaine in first stage labour.
Epidural analgesia was studied in 100 healthy Chinese women with uncomplicated pregnancies in first stage labour. Patients were randomly allocated to receive 8 ml of one of the following five solutions: bupivacaine 0.125% with fentanyl 50 micrograms or fentanyl 100 micrograms, bupivacaine 0.25% plain, bupivacaine 0.25% with fentanyl 50 micrograms or fentanyl 100 micrograms. ⋯ There was no difference in method of delivery or neonatal Apgar scores. The least concentrated mixture providing good quality analgesia for the first stage of labour was the combination of bupivacaine 0.125% with fentanyl 50 micrograms.
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Anaesth Intensive Care · Nov 1990
ReviewAccurate monitoring of neuromuscular blockade using a peripheral nerve stimulator--a review.
For normal anaesthetic practice, monitoring of neuromuscular blockade is best performed by stimulation of the ulnar nerve at the wrist with a peripheral nerve stimulator and evaluation of the response of the thumb. Determination of the initial threshold for stimulation in the awake patient to allow estimation of the current required for supramaximal stimulation is an important set-up procedure to improve accuracy. The degree of paralysis of specific muscle groups such as the diaphragm can be inferred from their sensitivity to neuromuscular blocking agents relative to adductor pollicis. Monitoring with different stimulation patterns allows a wide spectrum of muscle paralyses to be evaluated.
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Anaesth Intensive Care · Nov 1990
Randomized Controlled Trial Clinical TrialUnlimited clear fluid ingestion two hours before surgery in children does not affect volume or pH of stomach contents.
To determine the effect on gastric contents of unlimited clear fluid ingestion by children up to two and a half hours and then up to two hours before elective surgery, 228 healthy children (ages two to twelve years) were prospectively studied. During Phase I of this study subjects ingested unrestricted volumes and types of clear fluids up to three hours (control group) or two and a half hours before surgery. After establishment of adequate anaesthesia, gastric fluids were aspirated via an orogastric tube. ⋯ The methods for Phase II were unchanged except that unlimited clear fluids were permitted up to three hours (control group) or two hours preoperatively. In both Phase I and II, gastric volume and gastric pH were unaffected by reducing the fast to less than three hours. It is concluded that ingestion of unlimited clear fluids up to two hours before elective surgery does not affect gastric contents of healthy children.
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In a prospective study of one hundred obstetric patients given spinal anaesthesia using either a 25 or 26 gauge spinal needle, a significantly greater incidence of spinal headache and blood patch was found in the 25-gauge group. It is concluded that a 26-gauge needle should be used when performing spinal anaesthetics for obstetric procedures.
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Anaesth Intensive Care · Nov 1990
Case ReportsHypoxaemia during postoperative recovery using continuous pulse oximetry.
Continuous pulse oximetry monitoring was used to determine the incidence of hypoxaemia (arterial oxygen saturation less than or equal to 90%) occurring in the first hour of postoperative recovery. Of 107 patients studied, hypoxaemia was recorded in 80%. Twenty-eight (26%) of these patients had saturations below 80%. ⋯ We conclude that postoperative hypoxaemia is a particularly common occurrence even in patients otherwise considered healthy. Hence, pulse oximetry should be employed routinely during recovery. Where possible, monitoring should be performed continuously for at least 45 minutes.