Anaesthesia
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Review Case Reports
Massive lingual swelling following palatoplasty. An unusual cause of upper airway obstruction.
We report a case of upper airway obstruction as a result of delayed massive lingual swelling following routine cleft palate repair in an otherwise healthy 12-month-old girl. We believe that ischaemia and venous congestion were the causes of macroglossia, after prolonged use of the Digman Dott tongue retractor. In any difficult and lengthy repair, we recommend the prophylactic insertion of a nasopharyngeal airway under direct vision by the surgeons after surgery to prevent potential upper airway obstruction.
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Randomized Controlled Trial Clinical Trial
The effect of pre-operative oral fluids on morbidity following anaesthesia for minor surgery.
Postoperative morbidity and serum osmolality were studied in 46 patients who were encouraged to drink water until 3 h pre-operatively and 49 receiving the normal fasting regimen prior to minor surgery. There was significantly less thirst in the postoperative period in those patients allowed to drink and subjectively better recovery than after previous anaesthesia. There was no morbidity from ingestion of up to 11 of water 2.5 h pre-operatively. Although there was only a moderate improvement in postoperative recovery we feel that allowing patients to drink water pre-operatively improves patient comfort, especially since patients may have to fast for much longer than guidelines recommend, simply because of the traditional organisation of operating lists.
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We prospectively studied the relationship between upper facial sensory-evoked muscle potential amplitude, uterine contraction amplitude and heart rate in 20 healthy parturients during the first stage of labour. Monitoring began when minimal pain was reported and continued until severe pain occurred and extradural analgesia was established. Pain intensity was assessed by each patient using a 10 cm visual analogue score. ⋯ No constant relationship was seen between heart rate and uterine contraction. Following extradural analgesia (mean pain scores of 2.1 cm, SD 1.3 cm) a variable relationship between sensory evoked muscle potential and uterine contraction amplitude, and heart rate and uterine contraction, was recorded. A continuous display of the relationship between filtered sensory evoked muscle potentials of the frontalis muscle and uterine contraction may, in the future, permit an objective assessment of the adequacy of analgesia following extradural analgesia for the pain of labour.
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Randomized Controlled Trial Comparative Study Clinical Trial
Epidural diamorphine. A comparison of bolus and infusion administration in labour.
In a randomly allocated double blind study of 54 primigravidae, we examined the relative efficacy of the addition of diamorphine 3 mg to either an initial bolus or an infusion of bupivacaine. Both groups received an initial bolus of 10 ml of bupivacaine 0.25% followed by an infusion of bupivacaine 0.1% at 10 ml.h-1. Group 1 received diamorphine 3 mg in the bolus and group 2 received diamorphine 3 mg in the initial 100 ml of infusion solution. ⋯ Analgesia, assessed by visual analogue scores, was superior at 7h in group 2, but was similar at all other times. Sedation scores were significantly lower in group 2 for the first 3h and the incidence of nausea was significantly lower in group 2. The addition of diamorphine, whether as a bolus or added to an infusion of bupivacaine, results in similar quality of analgesia, but there is a reduction in side effects when diamorphine is administered in an infusion.
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Randomized Controlled Trial Comparative Study Clinical Trial
Postoperative epidural infusion of a mixture of bupivacaine 0.2% with fentanyl for upper abdominal surgery. A comparison of thoracic and lumbar routes.
Thirty-three patients who had undergone elective open cholecystectomy were studied in a prospective, randomised comparison of thoracic (n = 17) and lumbar (n = 16) epidural routes of administration of a mixture of bupivacaine 0.2% with fentanyl 10 micrograms.ml-1 for postoperative pain. Pain relief, cardiovascular stability, respiratory rate and side effects were assessed by a 'blinded' observer at specific times in the 24 h study period. ⋯ The incidence of side effects attributable to use of the lumbar epidural route was significantly higher than with the thoracic route (p < 0.05). This study supports the use of the thoracic epidural route for postoperative pain management after upper abdominal surgery.