Anaesthesia
-
Randomized Controlled Trial Comparative Study Clinical Trial
Epidural versus intramuscular fentanyl. Analgesia and pharmacokinetics in labour.
In a randomised double blind trial, 36 patients in the first stage of labour received either epidural or intramuscular fentanyl at the same time as the epidural test dose of bupivacaine. Analgesia was more rapid in onset and more complete in the epidural fentanyl group. ⋯ Plasma fentanyl concentrations showed wide interindividual variation, but after epidural fentanyl the peak occurred earlier. There was no correlation between analgesia and plasma fentanyl concentration, and epidural fentanyl produced superior analgesia but a systemic contribution to this effect cannot be ruled out.
-
Comparative Study
Forum. Femoral neck surgery using a local anaesthetic technique.
Thirty cases of femoral sub-capital fractures, Garden grades 1-4, were reduced and internally fixed with crossed Garden screws using femoral nerve block. In addition, sedation and analgesia was provided by low dose ketamine and diazepam. No deaths or other complications occurred in these patients. In a similar group of patients who received spinal analgesia in the same unit under similar conditions there was one death and two cerebrovascular accidents.
-
Randomized Controlled Trial Clinical Trial
Second stage of labour with or without extradural analgesia.
Two groups of parturients who had received selective extradural analgesia were studied. In Group A patients the regional block was allowed to wear off for the second stage of labour whereas in Group B patients' analgesia was maintained throughout labour. The maintenance of selective analgesia was of positive benefit to the mothers. They experienced much less pain, labour was not prolonged, dosage of bupivacaine was not increased, the forceps delivery rate was lower and there were fewer persistent malrotations.
-
Neurogenic pulmonary oedema is a not uncommon condition with a mortality that may exceed 90%. A fatal case in a 17-month-old child is reported. The literature is reviewed and current theories of the pathogenesis presented. Suggestions are made on how the condition might best be managed.