The Journal of international medical research
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Randomized Controlled Trial
Combined use of low-dose bupivacaine, colloid preload and wrapping of the legs for preventing hypotension in spinal anaesthesia for caesarean section.
We tested the hypothesis that using a combination of methods would result in a greater reduction in the incidence of hypotension due to spinal anaesthesia in caesarean sections compared with using each method on its own. A total of 120 patients were randomly allocated to the following four treatment groups: 10 mg bupivacaine 0.5% intrathecally plus 500 ml Ringer lactate solution (group B); 4 mg bupivacaine 0.5% plus 25 mug fentanyl plus 500 ml Ringer lactate solution (group F); 4 mg bupivacaine 0.5% plus 25 mug fentanyl intrathecally plus 500 ml Gelofusine intravenously (group G); and 4 mg bupivacaine 0.5% plus 25 mug fentanyl intrathecally plus 500 ml Gelofusine intravenously plus tight wrapping of the lower extremities with an Esmarch bandage (group E). ⋯ Hypotension was detected in 100% of the patients in group B compared with 70.0%, 46.7% and 23.3% of those in groups F, G and E, respectively. Hypotension was thus reduced by using a combination of several methods.
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Delirium is a common complication of critically ill patients and is often associated with metabolic disorders. One of the most frequent metabolic disorders in intensive care unit (ICU) patients is hyperglycaemia. The aim of this retrospective study of 196 adult ICU patients was to determine if there is an association between hyperactive delirium and blood glucose levels in ICU patients. ⋯ Hyperactive delirium was detected in 55 (28%) patients. Delirious patients showed significantly higher blood glucose levels than non-delirious patients Higher overall complication rates, length of ventilation, ICU stay and mortality rates were seen in the delirium group. In a multivariate analysis, glucose level, alcohol abuse, APACHE II score, complication by hospital-acquired pneumonia and a diagnosis of polytrauma on-admission all significantly influenced the appearance of delirium.
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This study investigated the effect of a pre-operative low dose of intravenous ketamine on tourniquet-induced haemodynamic changes. Ten minutes after induction of general anaesthesia, 0.1 mg/kg ketamine in 10 ml of saline (ketamine group, n = 14) or 10 ml of normal saline (control group, n = 14) were administered intravenously. ⋯ The control group had a greater percentage of patients with a 30% rise in blood pressure at 60 min after tourniquet inflation compared with the ketamine group (28.6% vs 7.1%), but this was not statistically significant. We conclude that a pre-operative low dose (0.1 mg/kg) of intravenous ketamine can prevent a systemic arterial pressure increase for at least 60 min after tourniquet inflation under general anaesthesia.