Anaesthesia
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Randomized Controlled Trial Clinical Trial
Quantifying the effect of isoflurane on mivacurium infusion requirements.
We evaluated the effect of different concentrations of isoflurane in a nitrous oxide/oxygen mixture on the infusion requirements of mivacurium in 60 adult surgical patients. Anaesthesia was induced with thiopentone and fentanyl, and intubation was facilitated with mivacurium 0.15 mg.kg-1. The patients were randomly assigned to one of four study groups. ⋯ The mean (SD) steady-state infusion requirements of mivacurium in patients receiving nitrous oxide-fentanyl anaesthesia or isoflurane 0.25-0.5 MAC were similar, ranging from 6.1 (2.2) to 5.1 (2.1) micrograms.kg-1.min-1. Isoflurane 1.0 MAC reduced mivacurium infusion requirements by 32% (p < 0.01). Interindividual differences in mivacurium infusion requirements were large.
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Clinical Trial Controlled Clinical Trial
Effects of topical benzocaine and lignocaine on upper airway reflex sensitivity.
We studied the degree and duration of effect on upper airway reflex sensitivity of oral benzocaine lozenges, nebulised lignocaine and lignocaine sprayed onto the vocal cords under direct vision, using low concentrations of ammonia as a stimulus to upper airway receptors. Ten minutes after the administration of oral benzocaine 20 mg the threshold response of the upper airway to ammonia (NH3TR) had risen significantly from baseline mean (SEM) of 680 (95) to 975 (109) ppm of ammonia with a return to baseline values after 25 min (n = 8, p < 0.05, repeated measures of ANOVA; p < 0.001, t-test). ⋯ The application of 4% nebulised lignocaine 4 ml significantly increased NH3TR from a baseline mean (SEM) of 770 (56) to a maximum of 1190 (63) ppm of ammonia with a significant elevation in the threshold persisting for 30 min (n = 8, p < 0.001, repeated measures of ANOVA; p < 0.05, t-test). The maximum elevations in NH3TR with the two methods of lignocaine delivery were significantly different (p < 0.01, 2-way ANOVA).
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In the early 1940s, Dr M. H. ⋯ The apparatus was essentially a combination of Water's to-and-fro soda-lime canister and Hewitt's ether inhaler. The description of the apparatus is followed by a brief historical note on Dr Armstrong-Davison.
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An epidural performed for obstetric analgesia was initially characteristic of a subdural block but subsequently behaved as a normal epidural. Radiological confirmation of the catheter having been subdural was established by performing a magnetic resonance imaging scan.
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Case Reports
Respiratory arrest in a parturient following intrathecal injection of sufentanil and bupivacaine.
A 19-year-old obstetric patient had a respiratory arrest shortly after receiving intrathecal sufentanil and bupivacaine as part of a combined epidural/spinal technique for pain relief in labour.