Anaesthesia
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Randomized Controlled Trial Clinical Trial
Continuous versus intermittent epidural analgesia. A randomised trial to observe obstetric outcome.
A randomised study of 381 women was carried out to compare the obstetric outcome after epidural analgesia maintained by an intermittent top-up regimen or with a continuous infusion. The two groups were well matched with respect to age, parity, mode of onset of labour and indication for epidural. ⋯ A reduction in the incidence of hypotension, cardiotocographic evidence of intrapartum fetal hypoxia and Caesarean section was associated with this. It is concluded that the maintenance of epidural analgesia by continuous infusion is a safe and reliable method and may be more advantageous and less labour intensive than the traditional intermittent regimen.
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Randomized Controlled Trial Comparative Study Clinical Trial
Cardiovascular effects of fibrescope-guided nasotracheal intubation.
The cardiovascular effects of fibrescope-guided nasotracheal intubation were compared to those of a control group of patients who were intubated using the Macintosh laryngoscope. The 60 patients studied received a standard anaesthetic technique which included a muscle relaxant and were allocated randomly to one of two groups immediately before tracheal intubation. Systolic and diastolic arterial pressures in the fibreoptic group were significantly lower than in the control group during the first minute after intubation. ⋯ The heart rate in the fibreoptic group was significantly higher than in the control group during all five minutes after intubation. The maximum increase in heart rate was significantly higher in the fibreoptic group. The cardiovascular responses to fibreoptic nasotracheal intubation under general anaesthesia should not cause undue concern in fit patients, but appropriate measures should be taken to prevent excessive tachycardia in compromised patients.
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Intravenous regional analgesia for foot surgery with an ankle tourniquet was used for 48 cases. Prilocaine 0.5% 3 mg/kg body weight was injected either quickly over about 2 minutes or slowly over about 5 minutes. The tourniquet was inflated either to occlusion pressure plus 100 mmHg or to occlusion pressure plus 200 mmHg. ⋯ The data suggest that slow injection with the high tourniquet inflation pressure is better, although the differences in leakage with an intact tourniquet were not statistically significant. Excellent analgesia was achieved in over 90% of patients and there were no complete failures. No dangerously high prilocaine plasma levels were produced and no serious side effects observed.