Anaesthesia
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Randomized Controlled Trial Clinical Trial
Antagonists of morphine-induced respiratory depression. A study in postoperative patients.
This double blind study showed the effect of four drugs, levallorphan, naloxone, doxapram and amiphenazole, an opiate-induced analgesia and respiratory depression. Satisfactory analgesia was induced by administration of morphine intravenously in a dose of up to 0.33 mg/kg; such a dose, however, produced significant depression of respiration. Administration of levallorphan, naloxone, and amiphenazole produced reversal of respiratory depression and analgesia. Doxapram reversed the respiratory depression but did not alter analgesia.
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A technique is described of epidural anaesthesia for electric Caesarean section which has a 98% success rate, and an acceptably low incidence of intra-operative pain. The essentials of the technique are to produce and maintain complete sensory block from S5 to T6, employing a two-stage injection of bupivacaine 0.5% (mean dose 23 ml) and the use of gravity to ensure sacral block. Despite the use of preoperative fluid loading and avoidance of caval occlusion, transitory hypotension occurred in 16% of patients. Vomiting, which occurred in 18% of patients, is a minor but distressing complication.
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Polyester resin was injected into the epidural space of fresh-adult cadavers to study the shape of the lumbar epidural space and the spatial relationship between the dura mater and vertebral canal. In most of the anatomical preparations the shape of the lumbar dural sac was distinctly triangular and in some cases a dorso-median fold of the dura was apparent. ⋯ Factors which may influence the shape and dimensions of the lumbar epidural space are discussed. It is suggested that these anatomical observations may have clinical significance in the practice of lumbar epidural analgesia.
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The effectiveness of epidural analgesia for uneventful labour was assessed in 200 patients who had received epidural blocks performed by trainee anaesthetists and whose subsequent management was supervised by trainee midwives. Although 88% of mothers were satisfied with the pain relief, only 46% had a completely painless labour after insertion of the epidural block. ⋯ Epidural analgesia is potentially highly effective, but in practice this seems to be related to the expertise of the anaesthetists and the midwives. Almost half the deliveries were instrumental, the proportion being greater for primipara, and this was presumably related to the epidural analgesia.