Anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Postoperative analgesia for Caesarean section using epidural methadone.
A prospective randomised double blind study was carried out to compare the use of epidural methadone, morphine and bupivacaine for pain relief after Caesarean section. The results indicate that methadone is the most effective agent with few side effects. Subsequently this method was used routinely for postoperative analgesia in all patients undergoing Caesarean section. A retrospective study of 178 patients having this method of analgesia was carried out and indicated that epidural methadone is an effective and safe method of postoperative pain relief.
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Case Reports
Factors associated with survival and eventual cerebral status following cardiac arrest.
Cardiac arrests at two acute hospitals were investigated over a 5-month period. The outcome expressed as short-term and long-term survival was correlated with diagnosis, age, sex and technical details of the resuscitation. Survivors were followed up for 3 months to detect any remaining cerebral deficit. ⋯ Survival was highest in patients suffering ventricular fibrillation following myocardial infarction where 16 out of 35 (47%) survived. Certain groups of patients were identified where the ultimate survival was predictably nil. Although some survived for short periods it was concluded that the attempted resuscitation in these patients was inappropriate and unjustified.
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The use of cutaneous liquid crystal thermometry (EZ Temp) as an estimate of core temperature during routine surgery was investigated in 20 patients. Seventeen per cent of the recordings made with the EZ Temp were more than 1 degree C different from oesophageal temperature. There was a poor correlation between EZ Temp values and both oesophageal and aural temperatures (r = 0.54 for both sites). We conclude that liquid crystal thermometry of the forehead is not sufficiently accurate to be used as an indicator of core temperature during routine surgery.
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The use of atracurium besylate, in small incremental doses, with continuous monitoring of neuromuscular function, is described during upper abdominal surgery in a patient with myasthenia gravis.
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The major problems of long-standing ankylosing spondylitis are described and the surgical and anaesthetic literature reviewed. The upper airway problems are discussed with reference to four cases and the advantages of an awake intubation technique are stressed.