Anaesthesia and intensive care
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Anaesth Intensive Care · Aug 1991
Randomized Controlled Trial Clinical TrialDoes combined epidural lignocaine and fentanyl provide better anaesthesia for ESWL than lignocaine alone?
The efficacy of epidural fentanyl combined with lignocaine 1.5% with adrenaline 1:200,000 was studied in a randomised, double-blind, controlled trial of two hundred patients undergoing extracorporeal shock wave lithotripsy with or without ancillary procedures. The quality of anaesthesia was assessed using linear analogue pain scores, the patient's impression, and the rate of intra-operative intervention by the anaesthetist. ⋯ The only significant difference lay postoperatively in that the fentanyl-ancillary procedure sub-group had less pain approximately one hour postoperatively (P = 0.01). In the context of this study and in the presence of an adequate autonomic and somatic local anaesthetic blockade, the addition of epidural fentanyl does not appear to confer any significant advantage other than to enhance postoperative analgesia.
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Anaesth Intensive Care · Aug 1991
Randomized Controlled Trial Comparative Study Clinical TrialThickly and thinly applied lignocaine-prilocaine cream prior to venepuncture in children.
EMLA cream (Astra Pharmaceuticals) which contains lignocaine and prilocaine, is widely used in a thick layer to reduce the pain associated with venepuncture. Application of smaller amounts of cream lowers cost and may reduce side-effects. The efficacy of a thick layer (using 2.0 ml) and a thin layer (using 0.5 ml) of lignocaine-prilocaine cream prior to venepuncture was compared in a randomised study of one hundred children. ⋯ Children in the thin layer study group experienced slight pain more often than children in the thick layer study group (P less than 0.01). No child in either group experienced moderate or severe pain. It is concluded that a thin layer of lignocaine-prilocaine cream is not as effective as a thick layer in producing the pain-free venepuncture which is desirable in children.
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Anaesth Intensive Care · Aug 1991
A survey of epidural analgesia practice in Western Australian obstetric units.
A survey of epidural practices in all obstetric units in this state was conducted to obtain information regarding epidural analgesia services, epidural conduct and management, management of complications and staff education. The survey revealed a diversity of practice and in some instances standards of care. While reflecting the regionalisation of services in this geographically vast state, the problems identified appear universal and are likely to be relevant on a broader and national scale. Practices are discussed and recommendations made with respect to improvement of management and continuing education.
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Anaesth Intensive Care · Aug 1991
Clinical Trial Controlled Clinical TrialDoes propofol have an anti-emetic effect? A prospective study of the anti-emetic effect of propofol following laparoscopy.
In order to investigate the putative anti-emetic effect of propofol, 53 patients undergoing gynaecological laparoscopy were given a standard anaesthetic including induction with thiopentone. At the end of surgery, the patients received either a sub-anaesthetic does of propofol or an equivalent volume of normal saline. There was no difference in the incidence of nausea and vomiting between the propofol and control group. It is concluded that low-dose propofol does not have an anti-emetic effect.
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Anaesth Intensive Care · Aug 1991
Level of consciousness on arrival in the recovery room and the development of early respiratory morbidity.
An audit review of 16,065 patients undergoing operative procedures under general anaesthesia was carried out to examine the relationship between early postoperative respiratory complications and the level of consciousness of patients on arrival in the recovery room. In patients aged over ten years, the incidence of respiratory complications was significantly (P less than 0.005) related to the level of consciousness independent of ASA grade or age. Since the level of consciousness of patients arriving in the recovery room could be modified by changes to anaesthetic practice it is concluded that a significant reduction in respiratory complications might be possible if anaesthetists used general anaesthetic techniques which returned patients awake to the recovery room.