Anaesthesia
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The upper oesophageal sphincter can prevent regurgitation of oesophageal contents into the pharynx following gastrooesophageal reflux in the awake patient. Upper oesophageal sphincter pressure was recorded with a Dent sleeve after hypnosis with midazolam (n = 7) and also during the rapid intravenous induction of anaesthesia with thiopentone (n = 16) or ketamine (n = 7). Thiopentone decreased mean (SD) sphincter pressure from an awake value of 43 (19) to 9 (7) mmHg (p less than 0.001) and midazolam from 38 (25) to 7 (3) mmHg (p less than 0.02). ⋯ Laryngoscopy (n = 30) caused a small increase in mean (SD) sphincter pressure to 13 (10) mmHg (p less than 0.001). Thiopentone caused a rapid fall in upper oesophageal sphincter pressure which usually started before loss of consciousness. These findings have implications for the timing of cricoid pressure application.
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Randomized Controlled Trial Clinical Trial
Epidural pethidine and bupivacaine in labour.
A double-blind randomised study was performed to assess the value of the addition of pethidine 50 mg to the initial dose of bupivacaine given for epidural analgesia in labour. Forty-nine patients received either 1 ml of saline (n = 24), or 50 mg of pethidine (n = 25), added to 9 ml of 0.25% bupivacaine as an initial injection for intrapartum epidural analgesia. There was a significant increase in the mean duration of analgesia in the pethidine group. However, pethidine did not increase the speed of onset of analgesia, or improve the quality of analgesia.
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Randomized Controlled Trial Clinical Trial
Thoracic epidural infusion for postoperative pain relief following abdominal aortic surgery: bupivacaine, fentanyl or a mixture of both?
Thirty patients who had undergone elective abdominal aortic surgery were studied in a prospective, randomised double-blind comparison of thoracic epidural 0.2% bupivacaine alone, thoracic epidural fentanyl alone and thoracic epidural 0.2% bupivacaine combined with fentanyl. Pain relief, pulmonary function, cardiovascular stability and side effects were assessed. ⋯ The incidence of side effects attributable to either epidural bupivacaine or fentanyl was low. This study supports the increasing use of epidural infusion analgesia for postoperative pain management after abdominal surgery.
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The important part of resuscitation in late pregnancy is the relief of aortocaval compression. A manoeuvre to relieve aortocaval compression (the human wedge) is described and evaluated. Eighteen qualified midwives performed basic life support in the supine and wedged position employing the human wedge. ⋯ There was no difference (p = 0.4761) in performance of mouth-to-mouth expired air ventilation between the two positions. External cardiac compressions were performed significantly better (p = 0.0005) in the wedged position than in the supine position. The human wedge may provide an alternative to other methods of relieving aortocaval compression.
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Randomized Controlled Trial Clinical Trial
Fentanyl-prilocaine mixture for intravenous regional anaesthesia in patients undergoing surgery.
The effect of the addition of 0.1 mg or 0.2 mg fentanyl to 40 ml 0.5% prilocaine in intravenous regional anaesthesia of the arm was investigated in 37 patients in a randomised, double-blind study. The characteristics of the sensory and motor block were studied. There was no difference in the speed of onset of analgesia in the groups (mean latency approximately 4 min in each group). ⋯ In the fentanyl groups, the incidence of central nervous system side effects was greater than in the control group (fentanyl 0.1 mg 7/13 patients, fentanyl 0.2 mg 6/12 patients, control 1/12 patients) (p less than 0.05). The plasma concentrations of prilocaine after cuff deflation were higher, in a dose-dependent fashion, in the fentanyl groups than in the control group, but the concentrations of prilocaine and fentanyl did not correlate with the symptoms. Postoperative nausea occurred only in the patients who had received fentanyl.