Anaesthesia
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Randomized Controlled Trial Clinical Trial
The effect of a combination of rectal diclofenac and caudal bupivacaine on postoperative analgesia in children.
Both caudal anaesthesia and non-steroidal anti-inflammatory drugs have been used in the management of postoperative pain in children. The aim of the present study was to evaluate the combination of caudal analgesia and rectally administered diclofenac in the treatment of pain following minor surgery in children. ⋯ Children given a caudal block alone were more likely to need analgesia in the first 24 h postoperatively. It would appear that the combination of a caudal block and rectal diclofenac in children undergoing minor lower abdominal surgery reduces the need for subsequent analgesia.
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Clinical Trial Controlled Clinical Trial
Correct positioning of the epiglottis for application of the Brain laryngeal mask airway.
Positioning of the epiglottis when the Brain laryngeal mask airway is in place was studied in 20 adult patients, using a new technique of insertion. The laryngeal mask was inserted when the anterior displacement of the mandible extended the epiglottis, thereby the providing an excellent airway in all patients. In 10 out of these 20 patients, the conventional technique of insertion revealed an incomplete extension of the epiglottis, and inadequate opening of the laryngeal inlet. It was concluded that the anterior displacement of the mandible during insertion of the laryngeal mask enhances the opening of the larynx, the result being an excellent airway.
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Case Reports
Anaesthesia for caesarean section in a patient with Klippel-Feil syndrome. The use of a microspinal catheter.
A 34-year-old woman with severe kyphoscoliosis, an immobile cervical spine, and short stature due to the Klippel-Feil syndrome presented for elective Caesarean section. She expressed a strong desire to remain awake during the procedure. We chose a technique using a spinal microcatheter to provide spinal anaesthesia on the basis that incremental control of the dose of bupivacaine would reduce the risk of 'high' block. ⋯ A total of 6.25 mg heavy bupivacaine, 7.5 mg plain bupivacaine, and 10 micrograms fentanyl were administered over 20 min. This provided anaesthesia up to T5 without significant effects on respiratory or cardiovascular function. The patient was successfully delivered of a healthy boy.
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An evaluation of the Universal PAC and Oxford Miniature Vaporizers for paediatric field anaesthesia.
A laboratory study has demonstrated that the Universal PAC and Oxford Miniature Vaporizers can be used for paediatric anaesthesia in drawover mode at varying ambient temperatures. Changes in tidal volume have minimal effect on the delivered concentration of halothane from either vaporizer but varying ambient temperature significantly affects the output of the Oxford Miniature Vaporizer. The Oxford performs well in continuous flow mode, which is of particular use for T-piece anaesthesia, whereas the Universal PAC does not perform adequately in this way.
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Multicenter Study Clinical Trial
Paravertebral blockade. Failure rate and complications.
The failure rate and complications were studied prospectively in 367 paediatric and adult patients who had received a thoracic or lumbar paravertebral block. The overall failure rate was 10.1%; adults 10.7%; children 6.2%. The frequency of complications were: hypotension: 4.6%; vascular puncture: 3.8%; pleural puncture: 1.1%; pneumothorax: 0.5%. Since these results are similar to those found with alternative methods, e.g. epidural, intrapleural and intercostal blocks, paravertebral block can be recommended as an effective, safe technique for unilateral analgesia in both adults and children.