Anaesthesia
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Randomized Controlled Trial Clinical Trial
Can pre-emptive lumbar epidural blockade reduce postoperative pain following lower abdominal surgery?
In a double-blind study, 36 patients who received a standard general anaesthetic for abdominal hysterectomy or myomectomy, received either 15 ml of bupivacaine 0.5% with adrenaline by lumbar epidural injection 15 min before surgery (group A) or the same dose at the end of surgery but before waking (group B). Pain was assessed for 24 h by cumulative morphine dose (self-administered by patient-controlled analgesia), visual analogue scale and verbal rating score. Patients were included for analysis if they were pain free on waking and for at least 2 h after. ⋯ Consequently, we compared the morphine dose, visual analogue scale and verbal rating score at 23 h in group A with those at 24 h in group B. Again there were no significant differences between the two groups. We were unable to demonstrate that epidural blockade had a significantly better effect on postoperative pain when administered before, rather than after, surgery.
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Case Reports
Cardiac arrest under anaesthesia in a child with previously undiagnosed Jervell and Lange-Nielsen syndrome.
A 7-year-old Sikh boy with a history of syncopal attacks and congenital deafness was admitted for elective adenoidectomy and examination of his ears under general anaesthesia. Immediately after induction of anaesthesia an ECG demonstrated T wave inversion in the CM5 lead. ⋯ A 12-lead ECG performed later demonstrated a prolonged Q-Tc interval (0.52 s). The child was diagnosed as having the Jervell and Lange-Nielsen syndrome.
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Randomized Controlled Trial Comparative Study Clinical Trial
Blood loss following tonsillectomy in children. A blind comparison of diclofenac and papaveretum.
One hundred and ninety-eight children, aged 3 to 12 years, who were scheduled for tonsillectomy were randomly allocated to receive either diclofenac 1.0 mg.kg-1 or papaveretum 0.2 mg.kg-1 by intramuscular injection after induction of anaesthesia. There were no significant differences between the treatment groups in operating theatre blood loss, the frequency of bleeding on the ward, or the need for operative haemostasis. ⋯ Similarly, marked restlessness in the recovery room was more frequent in the diclofenac group (p < 0.01). In both treatment groups there was an association between bleeding and restlessness during recovery so the increased bleeding in the diclofenac group may not be a direct effect.