Canadian journal of anaesthesia = Journal canadien d'anesthésie
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The first report of epidural analgesia for labour in a 26-yr-old woman with von Recklinghausen's neurofibromatosis is described. Epidural anaesthesia is often considered as contraindicated because neurofibromas may involve spinal cord and nerve roots. However, general anaesthesia was considered at high risk for this parturient on the basis of her previous medical and surgical history and of physical findings. The present observation suggests that epidural analgesia may be used in such circumstances provided that spinal cord neurofibromas have been ruled out by clinical and CT scan (or magnetic resonance imaging) examination.
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Randomized Controlled Trial Clinical Trial
Granisetron-dexamethasone combination reduces postoperative nausea and vomiting.
The prophylactic antiemetic efficacy of combined granisetron and dexamethasone was evaluated in a randomized double-blind manner in 88 patients undergoing general anaesthesia for major gynaecological surgery. Immediately after recovery from anaesthesia, patients received a single dose of either placebo (saline, n = 22), granisetron (20 micrograms.kg-1, n = 22), dexamethasone (8 mg, n = 22) or combined granisetron and dexamethasone (20 micrograms.kg-1 and 8 mg, respectively, n = 22) iv. ⋯ The incidence of adverse events postoperatively were not different among the groups. It is concluded that prophylactic administration of combined granisetron and dexamethasone is effective in preventing postoperative nausea and vomiting after anaesthesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of sodium nitroprusside- and esmolol-induced controlled hypotension for functional endoscopic sinus surgery.
The purpose of this study was to compare surgical conditions for functional endoscopic sinus surgery (FESS) under general anaesthesia during controlled induced hypotension, using either sodium nitroprusside (SNP) or esmolol. Twenty patients, assigned to receive either of the drugs as the primary hypotensive agent, were studied. The same surgeon, blinded to the hypotensive agent used and the haemodynamic variables, performed all the operations. ⋯ Pre-treatment MABP was 79.8 +/- 10.4 mmHg in the SNP group and 76.1 +/- 6.8 mmHg in the esmolol group. At mild SNP-induced hypotension, surgical conditions were poor (ACS = 3.63 +/- 0.22; mean +/- SEM), while in the esmolol group, ideal surgical conditions (ACS = 2.94 +/- 0.34) were recorded at MABP > 65 mmHg. The combined effects of increased venous drainage due to the reverse Trendelenburg position, hypotension as well as capillary vasoconstriction due to unopposed alpha-adrenergic effect on the mucous membrane vasculature in the esmolol group (as opposed to vasodilatation in the SNP group) probably caused the superior surgical conditions.
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Randomized Controlled Trial Clinical Trial
Awareness detection during caesarean section under general anaesthesia using EEG spectrum analysis.
This study examined the relationship between the EEG (spectral edge frequency 90-SEF90) and the occurrence of awareness defined for the purpose of this study as responsiveness to verbal commands. Fifty women undergoing general anaesthesia for elective Caesarean section were examined. Responsiveness to verbal commands was detected every minute in the period from the induction of anaesthesia to the delivery of the newborn using the Tunstall isolated forearm technique and correlated with the SEF90 value. ⋯ The EEG recordings started five minutes before induction and were recorded throughout anaesthesia. The incidence of responsiveness to verbal commands was lower in the ketamine group (24%) where the average SEF90 was 12.0 +/- 3 Hz, than in the thiopentone group (52%), where the average SEF90 was 18.09 +/- 3 Hz (P = 0.01). The results suggest that SEF values of < or = 8.6 Hz were sufficient to avoid responsiveness to verbal commands.
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Clinical Trial Controlled Clinical Trial
Effects of single-dose oral ranitidine and sodium citrate on gastric pH during and after general anaesthesia.
The effects on gastric pH of the H2-receptor antagonist ranitidine (R) with 0.3 molar (M) sodium citrate (SC) as an oral effervescent and those of plain SC were studied in 25 patients scheduled for elective surgery. Following induction of general anaesthesia, the gastric contents were evacuated via a nasogastric tube, and a pH electrode was placed in the stomach. Then, eight patients received R 300 mg plus SC dose (Group R300), ten received R 150 mg plus SC dose (Group R150), and seven received 50 ml SC alone (Group SC). ⋯ These values increased to 7.0 (6.2-7.5), 6.9 (6.3-7.3), and 4.9 (1.9-7.3), respectively, at emergence from anaesthesia (P < 0.05 for R300 vs SC and R150 vs SC). Two minutes after administration of R300 and R150, a mean (range) gastric pH of 6.8 (5.8-7.5), and 5.6 (1.2-7.0), respectively, was reached, and remained above 2.5 for 14 hr (P = NS). Plain SC increased the gastric pH within two minutes to a mean of 6.8 (6.7-7.0), and maintained it above 2.5 for six hours (P < 0.05 for R300 vs SC at 8, 10, 12, and 14 hr after induction).(ABSTRACT TRUNCATED AT 250 WORDS)