Anaesthesia
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The evoked motor responses to magnetic and electrical peripheral nerve stimuli were quantitatively assessed after vecuronium in 15 women undergoing gynaecological surgery. Anaesthesia was induced with thiopentone and fentanyl and maintained with intermittent doses of fentanyl and 66% nitrous oxide in oxygen. After immobilisation of both forearms in splints, the ulnar nerves were stimulated supramaximally every 10 s with a magnetic stimulator (Magstim Model 200) and an electric stimulator (Myotest) on opposite sides. ⋯ The difference in the evoked responses between the two types of stimulation was approximately 20% overall and was significant 2 min after vecuronium administration (p < 0.05). The rate of recovery of the evoked twitch responses was more rapid with magnetic than electric stimulation. It is concluded that magnetic stimulation of peripheral nerve is a useful technique for evaluating residual neuromuscular blockade.
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Hyperbaric oxygen treatment may require the concurrent administration of drugs. A study was performed to assess the suitability of the infusor device from the Baxter Patient-Controlled Analgesia system, for drug delivery during hyperbaric therapy. Thirty infusor devices were used to deliver 5% dextrose, 50% dextrose or propofol solutions under conditions 1 and 2.3 atmospheres of pressure. The increased pressure caused an increase in flow of 4.27%, 1.79% and 9.84% for 5% dextrose, propofol and 50% dextrose respectively.
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Randomized Controlled Trial Clinical Trial
Patient-controlled epidural analgesia with sufentanil following caesarean section: the effect of adrenaline and clonidine admixture.
Sixty patients, scheduled for Caesarean section were randomly allocated to receive by the epidural route in a double-blind fashion one of the following patient-controlled analgesia mixtures for the relief of postoperative pain: sufentanil 2 micrograms.ml-1 in 0.9% sodium chloride, sufentanil 2 micrograms.ml-1 + adrenaline 2.5 micrograms.ml-1, or sufentanil 2 micrograms.ml-1 + clonidine 3 micrograms.ml-1. Patient-controlled analgesia settings were a basal infusion rate of 2.5 ml.h-1, an incremental dose of 2.5 ml, a lockout interval of 10 min and a 1-h limit of 10 ml. ⋯ The quality of sleep appeared to be significantly better in the sufentanil/adrenaline group despite a significantly lower degree of sedation and higher incidence of pruritus. Treatment of pruritus with naloxone did not seem to influence the quality of analgesia.
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Randomized Controlled Trial Clinical Trial
Oral administration of midazolam as a premedicant for paediatric day-case anaesthesia.
Fifty-four children aged 1-10 years, scheduled for day-case anaesthesia were prescribed either oral midazolam 0.5 mg.kg-1 or a placebo preparation 30-60 min pre-operatively on a double-blind basis. On arrival at the induction room, anxiolysis was satisfactory in 23 out of 24 (96%) children who received midazolam compared with 12 out of 27 (44%) of those who received placebo (p < 0.001); at induction of anaesthesia these proportions were 21 out of 24 (88%) and nine out of 27 (33%) respectively (p < 0.001). ⋯ Similarly, the time to hospital discharge was longer in the midazolam group (244 vs 185 min) (p < 0.01). Analysis of behavioural questionnaires completed by parents 2 weeks after hospitalisation indicated that there were fewer postoperative behavioural disturbances in children premedicated with midazolam compared with controls (p < 0.05).