Anaesthesia
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A case is presented of a mother with unanticipated profound thrombocytopenia who received a continuous epidural anaesthetic for labour. No neurological sequelae or excessive bleeding occurred. It is clear, after a review of the literature, that more information is needed to define the lower limits of platelet count at which it is safe to proceed with epidural anaesthesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Advantages of the paramedian approach for lumbar epidural analgesia with catheter technique. A clinical comparison between midline and paramedian approaches.
Forty-nine patients, scheduled for transurethral resection of the prostate or a bladder neoplasm on 50 occasions, were studied. The patients were randomly allocated to one of the two methods of puncture, midline or paramedian. Technical difficulties and the occurrence of complications were recorded. ⋯ The catheter entered a vessel at first in two patients in each group. No significant differences were demonstrated between the groups in the extent of sensory and motor blockade. The study supports the view that the paramedian approach has technical advantages over the midline approach for lumbar epidural analgesia with catheter technique.
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Randomized Controlled Trial Comparative Study Clinical Trial
Regional anaesthesia for surgery of the forearm and hand. A technique of combined supraclavicular and discrete blocks.
Eighty patients who presented for surgery of the forearm or hand were allocated randomly to one of two groups. In Group A, surgery was performed under supraclavicular brachial plexus block only; a mixture of equal parts of prilocaine 1% and bupivacaine 0.5% without adrenaline was used. In Group B, supraclavicular brachial plexus block was performed using prilocaine 1% alone, but in addition discrete nerve blocks were performed at elbow level using 0.5% bupivacaine without adrenaline. Patients in Group B had a significantly shorter duration of unwanted postoperative motor blockade and a significantly longer duration of postoperative analgesia (p less than 0.005).
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of propofol and thiopentone for induction of anaesthesia for elective caesarean section.
Propofol 2.5 mg/kg was compared with thiopentone 5 mg/kg as an induction agent for elective Caesarean section. Thirty-two healthy women with cephalopelvic disproportion were included in an open randomised study. The placental transfer of propofol was also studied in 10 other mothers given a single dose of 2.5 mg/kg. ⋯ Rapid placental transfer and significant fetal uptake were detected for propofol. There was no significant neonatal depression as assessed by Apgar scores and blood gas analyses. Propofol appears to be a suitable alternative to thiopentone as an induction agent for anaesthesia in elective Caesarean section.