Anaesthesia and intensive care
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Anaesth Intensive Care · Feb 1994
Randomized Controlled Trial Comparative Study Clinical TrialPostoperative epidural fentanyl infusion--is the addition of 0.1% bupivacaine of benefit?
A randomised, double-blind controlled clinical trial was conducted in 90 women scheduled for major abdominal gynaecological oncology surgery to determine the effect of adding 0.1% plain bupivacaine to a thoracic epidural fentanyl infusion. Following combined epidural and general anaesthesia, patients were randomised to receive epidural fentanyl 10 micrograms/ml, with (group FB) or without (group F) bupivacaine. After an initial 50 micrograms bolus of fentanyl, infusion rate was adjusted according to need between 2 and 10 ml/hr for 48 hours. ⋯ There was no significant difference between groups with respect to side-effects or lower limb weakness, although fewer patients in group FB could be mobilised on the morning of the first postoperative day (P < 0.01). Nevertheless, all study patients were ambulant by the same afternoon. We concluded that, in this patient population, the addition of 0.1% bupivacaine to a thoracic epidural fentanyl infusion was beneficial in the early postoperative period.
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Anaesth Intensive Care · Feb 1994
Randomized Controlled Trial Clinical TrialIntraoperative and postoperative analgesia using intravenous opioid, clonidine and lignocaine.
The postoperative analgesia afforded after colonic surgery by IV opioid, clonidine and lignocaine given intra- and postoperatively was evaluated. In a double-blind randomised trial, 80 male patients scheduled for colonic resection under general anaesthesia received fentanyl 5 micrograms.kg-1 at induction and another 4 micrograms.kg-1 before skin incision (group A) or fentanyl (same dose) plus clonidine 4 micrograms.kg-1 in 20 min + 2 micrograms.kg-1.h-1 (group B, C) or fentanyl plus clonidine (same dosage) plus lignocaine 2 mg.kg-1 before skin incision, repeated before peritoneal incision and retractor placement (group D). In the four groups, intraoperative boluses of fentanyl 2 micrograms.kg-1 were given in response to the painful stimulation of the procedure. ⋯ No differences were noted between the group B, C, D. Pain analogue scores were better in groups B, C, D compared with group A (P < 0.001). Sedation and side-effects were not increased in groups B, C, D.(ABSTRACT TRUNCATED AT 250 WORDS)
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Past studies concerning postoperative apnoea in infants were identified and reviewed. A total of only 200 former preterm infants having minor surgery under general anaesthesia have been prospectively studied. The incidence of apnoea after general anaesthesia is approximately 30%, and is inversely related to postconceptual age. ⋯ No patient characteristic apart from postconceptual age has enough sensitivity and specificity to identify a high-risk group. The use of spinal anaesthesia or methylxanthines may reduce the incidence of postoperative apnoea, but again the evidence is not strong. Recommendations concerning the timing of elective surgery and the use of postoperative respiratory monitoring in the former preterm infant can only be made cautiously in view of the paucity of data on which to base them.
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All Fellows of the Faculty of Anaesthetists, Royal Australasian College of Surgeons (now Australian and New Zealand College of Anaesthetists) were surveyed by mail regarding their use of prophylactic atropine. They were asked whether their usual practice was to give atropine for the following indications: premedication, induction of anaesthesia, intubation of the trachea, one dose of suxamethonium, a second dose of suxamethonium, halothane anaesthesia, oropharyngeal surgery, bronchoscopy and eye surgery. For each indication they were asked for details regarding their practice concerning neonates, infants, children and adults. ⋯ The only indication for which a convincing majority (> 80%) of anaesthetists agreed that prophylactic atropine should be given was when a repeated dose of suxamethonium was to be given to neonates, infants or children. A large proportion of anaesthetists (> 80%) agreed that atropine is not necessary prior to halothane anaesthesia in all age groups, nor as premedication, at induction, at intubation, prior to oropharyngeal surgery or prior to eye surgery in adults. These results were compared with the practice at a major paediatric hospital where the practice is not to use routine prophylactic atropine.