Anaesthesia
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Clinical Trial Controlled Clinical Trial
Relief of injection pain in adults. EMLA cream for 5 minutes before venepuncture.
The effectiveness of skin anaesthesia after 5 minutes' topical application of a lignocaine-prilocaine cream was evaluated. One hundred and twenty patients estimated the pain of antecubital venepuncture both on a linear scale and verbally after use of the cream for either 5 or 60 minutes, a placebo cream or no treatment. Reported pain was significantly less after only 5 minutes of the lignocaine-prilocaine cream (p = 0.002). The cream can be used to relieve the pain of all routine injections.
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An 11-day-old neonate with renal failure caused by dysplastic kidneys was anaesthetised with thiopentone, vecuronium, nitrous oxide and oxygen, for insertion of a long-term peritoneal dialysis catheter. Complete neuromuscular block of 210 minutes' duration ensued after the initial dose of vecuronium (97 micrograms/kg). Partial block persisted for a further 30 minutes. The prolonged neuromuscular block in this case may have been because of proportionately greater dependence on renal clearance of vecuronium in neonates.
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A new needle, 120 mm long and 26 gauge in diameter, has been introduced for subarachnoid anaesthesia. The resistance to flow through the needle was measured using a pressure monitor infusion pump and compared with the resistance to flow through a 90-mm 26-gauge needle; there was a threefold increase in resistance in the 120-mm needle compared to the 90-mm needle, which could not be explained by the difference in length alone and must reflect a decrease in the internal diameter of the long needle. This results in difficulty in identifying the subarachnoid space by backflow of cerebrospinal fluid.
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The laryngeal mask airway was used in 200 children during a variety of surgical procedures. Some problem with the use of the device was encountered in 47 cases (23%), but in only five cases (2.5%) were the problems serious enough to warrant abandonment of its use. ⋯ The mask was used in 16 children with known airway problems. It is concluded that the size 2 laryngeal mask airway can be successfully used within the weight range 6-30 kg.
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The records of 160 day-care surgical patients who received intrathecal anaesthesia were reviewed. No major complications were recorded. ⋯ The occurrence of postspinal headache in patients over the age of 45 years was significantly less frequent (p less than 0.05) than in younger patients. Intrathecal anaesthesia was acceptable to 91% of outpatients in this group.