Anaesthesia
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The ability of a target-controlled propofol infusion system to provide sedation for 40 patients undergoing surgery under regional blockade was assessed. Eighty-eight per cent of the total infusion time was at the desired sedation level with little oversedation. ⋯ The pharmacokinetic algorithm performed as well when used for sedation as for total intravenous anaesthesia. The predicted and measured blood propofol concentrations showed a bias of -12% and a precision of 34%.
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Sixty adult patients following general surgical operation were treated with patient-controlled analgesia using morphine. Patients were allocated into three groups to receive: no background infusion, a 1 mg.h-1 or a 2 mg.h-1 background infusion. The other controls on the patient-controlled analgesia machine were set to allow a maximum dose of morphine of 6 mg.h-1 to each group. ⋯ Patients who received a background infusion of 2 mg.h-1 had an increased incidence of nausea (p < 0.05). A background infusion of 1 mg.h-1, with a 1 mg bolus dose and a 12 min lockout interval provided acceptable pain relief without excessive nausea. In all three groups the ratio of analgesic requests to successful deliveries correlated with the degree of pain reported by visual analogue score (p = 0.0001).
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Intravenous suxamethonium, in a dose as small as 0.1 mg.kg-1, has been found to be reliable in the treatment of laryngeal spasm. Three episodes of vocal cord spasm observed during direct laryngoscopy were relieved by this dose of suxamethonium.
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The records from 34,819 obstetric epidurals performed at Birmingham Maternity Hospital over the period 1969-1988 were examined. During that time there were 460 dural taps (overall incidence 1.3%). Of the methods used to detect the epidural space, loss of resistance to injection of saline was associated with the lowest incidence of dural tap (0.6%). ⋯ Elective forceps delivery conferred no additional benefit, and tended to delay the onset of headache. Blood patches were performed on 135 patients and provided complete relief of headache in 93 (68%). A further 23 patients (16%) obtained partial relief.