Anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of the addition of three different doses of sufentanil to 0.125% bupivacaine given epidurally during labour.
In a double-blind, randomised, prospective study 150 women in labour received intermittent epidural injections of 10 ml 0.125% bupivacaine with adrenaline (1:800,000) with 5, 7.5 or 10 micrograms of sufentanil added. The onset, duration, and quality of analgesia were compared. Motor block, type of delivery and neonatal Apgar scores were noted. ⋯ Motor blockade and type of delivery did not differ between the groups and there were no differences in neonatal Apgar scores. No patient required more than three injections. We conclude that 7.5 micrograms sufentanil is the optimal dose to add to intermittent epidural injections of 10 ml 0.125% bupivacaine with adrenaline (1:800,000) for pain relief in labour.
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In developing countries like Nepal, anaesthetic compressed gases, especially nitrous oxide, are expensive and in short supply and anaesthetic techniques must equally use oxygen and volatile anaesthetics sparingly. We have designed a non-rebreathing anaesthetic system which meets these requirements. An Ambu-E anaesthetic valve and self-inflating Ambu bag connected to a Bain system form a non-rebreathing system which uses ambient air to supplement a mixture of low flow oxygen and halothane. ⋯ A graphical analysis of gas flow predicts that the system is almost 100% efficient, in that almost all of the oxygen and halothane will enter the alveoli. Our experience confirms that this is a safe, simple and economical method for inhalation anaesthesia. We recommend it for locations where anaesthetic machines and mechanical ventilators are lacking, and where medical oxygen is in short supply.
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We performed a questionnaire survey to establish the current and intended practice of chair dental anaesthesia amongst recently appointed consultants, and senior registrars within the Mersey Region. Only 26% of the consultants surveyed practised chair dental anaesthesia, however, more consultants would have had their anaesthetic sessions allowed. Consultants performed 4.62 +/- 3.5 sessions per month and anaesthetised 8.0 +/- 2.27 patients per session. ⋯ Sixty-eight per cent of senior registrars declared an interest in chair dental anaesthesia. This group had received significantly more training (p < 0.005) in dental anaesthesia than those with no interest. Most anaesthetists (52/71) felt that chair dental anaesthesia was acceptable in centres approved to Poswillo standards; 16 anaesthetists felt that it should be confined to a hospital environment and three felt that it should not be performed at all.
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One hundred and sixty six patients were questioned by means of a multiple choice questionnaire, to determine their knowledge of peri-operative care, anaesthesia and the rôle of anaesthetists. In general, knowledge was good, but there were some important misconceptions; in particular, 28.3% of respondents thought that fasting referred to food only, and not to fluid intake. In addition, 47.6% of respondents considered pain to be a necessary part of the healing process and 38.6% believed that it was something that just had to be endured. When forthcoming anaesthesia is discussed, anaesthetists need to ascertain that patients really do understand the language used.