Anaesthesia
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This study examines the changing pattern of maternal analgesia administration during the decade 1970-1979. In addition, the relationship between analgesia, anaesthesia and the infant's Apgar score was documented. Approximately 40000 deliveries to South Glamorgan residents were included in the study. ⋯ Respiratory depression following Caesarean section remains a problem. The group delivered by elective Caesarean section contained a substantial proportion of infants with a low Apgar score; 30% had an Apgar score less than 8 and 10% had a score of less than 4. Likely causative factors include undue sensitivity of the infants' respiratory centre and aortocaval compression during surgery.
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Comparative Study
Serum morphine levels. A comparison between continuous subcutaneous infusion and continuous intravenous infusion in postoperative patients.
A study was undertaken to compare continuous subcutaneous infusions of morphine with continuous intravenous infusions in patients whose lungs were mechanically ventilated for 24 hours postoperatively. Serum morphine levels were measured after the end of surgery and at 6, 12, 18 and 24 hours in nine patients receiving continuous subcutaneous morphine and in four patients receiving continuous intravenous morphine given at the same rate. ⋯ The differences in the serum morphine levels and in the requirements of phenoperidine were not statistically significant. We conclude that a continuous subcutaneous infusion of morphine is a simple and effective means of achieving postoperative analgesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Alfentanil in minor gynaecological surgery: use with etomidate and a comparison with halothane.
Etomidate was used to induce anaesthesia in 50 healthy subjects undergoing minor gynaecological surgery who were randomly divided into two groups, one receiving alfentanil 8 micrograms/kg intravenously immediately prior to induction of anaesthesia with etomidate, and the other halothane as required to maintain adequate anaesthesia. There was a highly significant reduction in the incidence of myoclonia and involuntary movement and significant reduction of pain on injection in the alfentanil group. Tests of recovery performed in the 60 minutes following anaesthesia suggested that supplementation with alfentanil led to more rapid recovery than halothane.
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A prospective study was completed of 30 shocked patients admitted consecutively to an intensive therapy unit; the majority of the patients had shock of septic origin. Measurements were made of whole blood lactate together with mean arterial pressure, hourly urine volume and core: peripheral temperature difference at the start of treatment and 3 and 24 hours later. Serial lactate measurements were better at predicting outcome than single measurements. However, lactate measurements were much less valuable than serial measurements of the simple haemodynamic variables.