Anaesthesia
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Randomized Controlled Trial Clinical Trial
Gastric emptying following caesarean section and the effect of epidural fentanyl.
The rate of absorption of paracetamol following oral administration was used as an indirect measure of the rate of gastric emptying. This was to determine the effect on gastric motility of the addition of fentanyl to a solution of local anaesthetic given into the epidural space to provide pain relief following Caesarean section. ⋯ The area under the curve of the graph of plasma paracetamol concentration versus time was calculated for each subject at 45 and 90 minutes after administration of the epidural injection, and this value was used as an index of the rate of gastric emptying. This study demonstrated that gastric emptying may be normal immediately following Caesarean section under epidural anaesthesia, but that if fentanyl is added to the epidural solution, gastric emptying is significantly slower in the first 45 minutes following surgery (p less than 0.05).
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Continuous noninvasive blood pressure measurement is of great potential use in the critically ill. This study was designed to find out whether measurements of blood pressure by a Finapres accurately represented intra-arterial pressure. ⋯ There was an unpredictable but usually stable difference between measurements from the two sources; this difference varied in magnitude and direction in individual patients. At present the Finapres cannot be recommended as a substitute for intra-arterial blood pressure measurement in the critically ill.
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An 8-week survey was conducted to determine whether the introduction of low-flow anaesthesia (a fresh gas flow of 4 litres/minute or less) into routine use would be acceptable to members of a representative anaesthetic department and if the consequent reduction in use of volatile anaesthetics would result in financial savings. The hourly consumption of the volatile agents was measured during anaesthesia conducted using either conventional or low fresh gas flows. Anaesthetists' acceptance of low-flow anaesthesia was assessed using a questionnaire. ⋯ A 54.7% reduction in the consumption of isoflurane and a 55.9% reduction in that of enflurane was found. Of the 28 anaesthetists at the hospital, 21 would use low-flow anaesthesia routinely. The routine use of low-flow anaesthesia would therefore be acceptable and could result in annual savings of 26,870 pounds at Northwick Park Hospital.
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The clinician's appearance is often considered a symbol which identifies and defines specific characteristics of the individual. Opinion of both lay and medical personnel on appropriate clothing inclines towards formal dress. ⋯ However, when 138 patients were asked to rate the desirability of items of clothing for a male hospital doctor they expressed a preference for traditional clothing; a suit was rated as desirable and jeans as one of the four most undesirable items. We conclude that despite the conservatism of expressed opinions, the clothing worn by the anaesthetist is irrelevant to the patient's satisfaction with the visit.
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Randomized Controlled Trial Comparative Study Clinical Trial
The effect of a priming epidural injection of adrenaline on epidural blockade with bupivacaine.
Twenty-four patients receiving epidural anaesthesia were studied to test the hypothesis that 1:200,000 adrenaline administered into the epidural space 5 minutes before 20 ml bupivacaine 0.5% would improve nerve block and delay systemic absorption of the local anaesthetic. Group A/B received 20 ml adrenaline 1:200,000 5 minutes before 20 ml bupivacaine 0.5%, group S/BA 20 ml saline followed by 20 ml bupivacaine 0.5% with 100 micrograms adrenaline, and group S/B saline 20 ml followed by 20 ml plain bupivacaine 0.5%. ⋯ In both adrenaline groups a more prolonged epidural block and increased efficacy were noted, although this was only significant for the duration of block at T6 (p = 0.023) and duration of motor block at Bromage level 1 (p = 0.016) in group A/B. There seems little clinical advantage in administering adrenaline 5 minutes before bupivacaine.