Anaesthesia
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Randomized Controlled Trial Clinical Trial
Lignocaine test dose to detect intravenous injection.
The accidental intravascular injection of bupivacaine or etidocaine epidurally has resulted in several maternal deaths. To be effective, a test dose must allow detection of intravenous catheter placement and prevent accidental intravenous injection. This study was designed to determine the dose of lignocaine required for this purpose. ⋯ At 1 min intervals the patients were asked about subjective symptoms produced by this 'test dose'. In group 2 only 50% of patients reported a positive test dose, whereas in the patients of group 3, a significantly greater percentage (95%) had a positive test dose (p < 0.01). This suggests that the use of 1 mg.kg-1 lignocaine as a test dose would result in a significantly higher sensitivity for detecting intravascular injection than the use of 0.5 mg.kg-1.
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Randomized Controlled Trial Clinical Trial
The effect of midazolam premedication on implicit memory activation during alfentanil-nitrous oxide anaesthesia.
Eighty-three patients were given midazolam 0.1 mg.kg-1 by intramuscular injection as premedication before general anaesthesia with alfentanil-nitrous oxide. During anaesthesia patients were presented (through headphones) with either statements about common facts of some years ago (group A) (n = 43) or new verbal associations, e.g. names of fictitious, nonfamous people (group B) (n = 40). ⋯ In this study we found no explicit or implicit memory for the auditory information presented during anaesthesia. Midazolam premedication can prevent implicit memory activation during alfentanil-nitrous oxide anaesthesia.
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Randomized Controlled Trial Clinical Trial
Forced-air warming maintains normothermia during orthotopic liver transplantation.
We evaluated the efficacy of forced-air warming to maintain normothermia during liver transplantation. In a prospective, clinical trial 20 patients were randomly assigned to routine thermal management (circulating-water mattress set at 42 degrees C, intravenous fluid warming to 37 degrees C and passive insulation) or routine management with additional forced-air warming of head, chest, and arms. Core temperature was measured in the pulmonary artery. ⋯ Despite the relatively high ambient temperature, patients warmed only with a circulating-water mattress and passive insulation became hypothermic during surgery. In contrast, when forced-air warming was added to this routine thermal management, patients were normothermic at the end of surgery. Forced-air warming prevented intra-operative hypothermia during liver transplantation.
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Randomized Controlled Trial Clinical Trial
The effects of 2% lignocaine gel on incidence of retching with the use of the laryngeal mask airway.
This randomised, single-blind study investigated the incidence of retching during emergence from general anaesthesia with a laryngeal mask airway in place. Eighty four patients, ASA grade 1 and 2, aged 15 to 60 years, were randomly divided into two groups. Each patient received fentanyl 1 microgram.kg-1 and propofol 2 mg.kg-1 for induction. ⋯ The patients were allowed to wake up at the end of surgery with the laryngeal mask airway in place while a blinded observer observed for retching. The age, sex, weight and duration of surgery were similar in both groups. The test group had a significantly lower incidence of retching on emergence from general anaesthesia with the laryngeal mask airway in place (p < 0.005, Chi-squared test).
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Protein S is a nonenzymatic and vitamin K-dependent cofactor of activated protein C. Without protein S, the anticoagulant function of protein C is almost depleted and thrombotic events occur. We report a parturient with hereditary protein S deficiency in whom the risk of thromboembolism was further complicated by pregnancy and who required emergency Caesarean section for fetal distress.