Anaesthesia
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Review Case Reports
Spinal haematoma following epidural analgesia. Report of a patient with ankylosing spondylitis and a bleeding diathesis.
A patient who developed an epidural haematoma with multifactorial aetiology (bleeding diathesis, ankylosing spondylitis, chronic alcoholism and acute pancreatitis) after epidural analgesia for pain relief is described. Our conclusion is that adequate laboratory screening of blood coagulation, including platelet count, should be carried out in this category of patient before attempted epidural blockade, the risks of which must be weighed against the benefits. The block should be allowed to wear off intermittently and repeated neurological assessment performed if an epidural catheter is used for repeated injections or for a continuous infusion of local anaesthetic. Neuroradiological examination should be carried out promptly if an epidural haematoma is suspected and surgical decompression performed without delay if the diagnosis is confirmed.
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Ninety patients scheduled to undergo minor gynaecological surgery were divided into three groups. Group 1 received propofol only, for both induction and maintenance of anaesthesia. ⋯ The incidence of nausea in group 1 was 0%, in group 2, 3.4% and in group 3, 9.4%. No patient vomited.
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Randomized Controlled Trial Comparative Study Clinical Trial
Recovery times and side effects after propofol infusion and after isoflurane during ear surgery with additional infiltration anaesthesia.
Two anaesthetic procedures that did not include nitrous oxide were compared in a randomised study of 50 patients for tympanoplasty and tympanoscopy: propofol given for induction and maintenance, and thiopentone-isoflurane given for induction and maintenance, respectively. Induction in the first group was with a bolus injection of propofol and the same agent was given for the duration of anaesthesia by continuous intravenous administration. Thiopentone was given until loss of the eyelash reflex and anaesthesia maintained with isoflurane 0.4-2.0%. ⋯ The two patient groups were analysed for age, sex and weight as well as for side effects during the induction, maintenance and recovery periods, such as coughing, vomiting, venous pain, spontaneous movements, singultus, headaches, dysrhythmias and psychic disorders possibly due to anaesthesia. Side effects were moderate in both groups. Recovery time was statistically significantly shorter in the propofol group and the patients in this group appeared to be much more aware after recovery than those in the thiopentone-isoflurane group.
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Propofol and methohexitone were evaluated as hypnotics in a total intravenous anaesthesia technique without nitrous oxide in 50 patients of ASA grade 1 or 2. Analgesia was provided by a constant alfentanil infusion and the depth of anaesthesia was controlled by varying the infusion rate of propofol or methohexitone. Induction and intubation responses were smooth and moderate in the propofol group and side effects were few. ⋯ Postoperatively 96% of the propofol patients were clear-headed within 20 minutes, in contrast to only 48% in the methohexitone group. We conclude that propofol together with alfentanil, both given by a bolus plus infusion technique, provide controllable and satisfactory total intravenous anaesthesia without recourse to nitrous oxide or other inhalational agents. Methohexitone was not as satisfactory as propofol.
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Comparative Study
An additional tactile test. Further developments in tactile tests to confirm laryngeal placement of tracheal tubes.
An additional clinical test to confirm laryngeal placement of tracheal tubes is described. Using the new test, placement was confirmed in all of 50 patients studied in whom difficulty would have been anticipated using previously described tactile tests (male patients with lower molar teeth). Two anaesthetists with small hands averaged 98% confirmations in two series each of 100 consecutive unselected intubations. ⋯ The three tactile tests are reviewed and analysed. In the authors' combined experience of 14 cases of difficult laryngoscopy the tests gave reliable confirmation in 12 patients. Familiarity with these tests is stressed to be important for their reliable implementation.