Anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
The optimum concentration for epidural fentanyl. A randomised, double-blind comparison with and without 1:200 000 adrenaline.
A randomised, double-blind study comparing a variety of different concentrations of fentanyl with and without 1:200 000 adrenaline is described. It was shown that the quality and duration of analgesia with epidural fentanyl was concentration-dependent below 10 micrograms/ml, but that the addition of adrenaline abolished this phenomenon. The rate of failure to achieve any analgesia was very high with the more dilute solutions, but adrenaline reversed this problem. In general the incidences of side effects were related to the concentrations of fentanyl used and apart from itching, the incidences of these side effects were reduced by the addition of adrenaline.
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This is the report of the second of two studies conducted by the Association of Anaesthetists of Great Britain and Ireland based on anonymous reports of deaths within 6 days of anaesthesia. One hundred and ninety-seven detailed reports were received during 1981; 43% were found by assessors to have nothing to do with anaesthesia, 41% to be partly due to, and 16% totally due to anaesthesia. These figures confirm earlier results reported by the same system. It is important to have the opinion of the two clinicians (anaesthetist and surgeon) separately and not to ignore either in a study which attempts to identify aspects of clinical medicine which might be improved.
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Case Reports
Hypersensitivity reactions to Althesin infusion: measurement of complement involvement.
Two cases of hypersensitivity reactions in the course of slow infusion of Althesin are reported. Serial examination of their complement system showed a marked activation of the alternate pathway which returned almost to normal within 24 hours.
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Two groups of insulin dependent diabetic subjects have been studied: six undergoing general surgical procedures and six undergoing hypothermic cardiopulmonary bypass surgery for coronary artery vein grafting. Intravenous glucose insulin mixtures were infused from the onset of surgery in both groups of patients, supplying 0.4 units of insulin per gram of glucose per hour, and 0.6 units of insulin per gram of glucose per hour in general and cardiac surgical patients respectively. ⋯ Five non-diabetic subjects who underwent surgery for coronary artery venous bypass grafting were also studied. They developed significant postoperative hyperglycaemia (5.0, SEM 0.2, mmol/litre pre-operatively, compared with 8.8, SEM 0.7, mmol/litre p less than 0.03 at 1 hour and 10.2, SEM 1.7, mmol/litre, p less than 0.02 at 4 hours after bypass terminated).