Anaesthesia and intensive care
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Anaesth Intensive Care · Nov 1986
Randomized Controlled Trial Comparative Study Clinical TrialA prospective randomised trial comparing spinal anaesthesia using hyperbaric cinchocaine with general anaesthesia for lower limb vascular surgery.
One hundred and one patients were randomly allocated to have their peripheral vascular surgery performed under general anaesthesia (51 patients) or spinal anaesthesia (50 patients). Intraoperative haemodynamic changes were markedly different between the two groups with a higher incidence of hypotension in the spinal group (72% vs 31%) and a higher incidence of hypertension in the general anaesthesia group (22% vs 0%). Blood loss was significantly less in the spinal group (560, SD 340, ml vs 792, SD 440, ml). ⋯ Two patients in the spinal group had myocardial infarcts, both had been treated for bradycardia and hypotension intraoperatively, and one died. There was a significantly higher incidence of postoperative chest infection in the general anaesthesia group (33% vs 16%). There was no significant difference between the groups in the incidence of postoperative confusion, or lower limb amputation rate or need for further surgery prior to hospital discharge.
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Anaesth Intensive Care · Nov 1986
Anaesthesia for patients with arthrogryposis multiplex congenita: what is the risk of malignant hyperthermia?
Arthrogryposis multiplex congenita has been linked with malignant hyperthermia. A review of the anaesthetic experience at the Royal Alexandra Hospital for Children over a 32-year period revealed no episode of malignant hyperthermia occurring in patients with arthrogryposis multiplex congenita despite many and varied exposures to known triggering agents.
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Anaesth Intensive Care · Nov 1986
Randomized Controlled Trial Clinical TrialComparative cutaneous histamine release by neuromuscular blocking agents.
Normal values of cutaneous wheal diameter following intradermal injection of six neuromuscular blocking drugs were determined. The relative cutaneous histamine-releasing ability of each drug was derived from calculated dose-response relationships. Equipotent neuromuscular blocking doses were found to have a cutaneous histamine releasing ability relative to pancuronium (= 1) of vecuronium 1.1: suxamethonium 1.7; alcuronium 5; atracurium 52; d-tubocurarine 172. A significant (P less than 0.001) variation was found between the dose-response slopes perhaps suggesting a variation in the mechanism of histamine release.
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Anaesth Intensive Care · Nov 1986
Clinical Trial Controlled Clinical TrialShivering related to epidural blockade with bupivacaine in labour, and the influence of epidural pethidine.
A prospective survey of two hundred patients who received an epidural block in labour was performed in order to determine the incidence and severity of shivering, and the influence of likely associated factors. Twenty-two of the patients who shivered took part in a double-blind trial to see if epidural pethidine 25 mg, versus saline, had any effect upon shivering. Fifty per cent of patients shivered soon after the initial dose of bupivacaine. ⋯ Shiverers were more likely to feel cold than non-shiverers (P less than 0.001) but shivering was generally regarded by patients as a trivial symptom, only 13% describing it as very irritating. Shivering was abolished or considerably diminished within ten minutes in all patients who received epidural pethidine 25 mg, whereas there was no change in eight out of eleven patients who received epidural saline. These results are significant (P less than 0.01), and demonstrate that shivering following epidural blockade can be effectively treated with small epidural doses of pethidine.
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Anaesth Intensive Care · Nov 1986
Relationship between methaemoglobin production and methylene blue plasma concentrations under general anaesthesia.
Recently, a family tree with a predisposition for the gene of multiple endocrine neoplasia Type 1 has been identified in Tasmania. As the surgical identification and localisation of parathyroid adenomas is facilitated by the administration of methylene blue, an opportunity has presented to measure the plasma concentration of methylene blue and methaemoglobin production. ⋯ Mean peak methylene blue concentrations of 3.72 micrograms l-1, mean percentage methaemoglobin of 10.0 and a PaO2 within acceptable clinical ranges were found. No apparent relationship between methylene blue concentration and methaemoglobin production was found.