Anaesthesia
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Randomized Controlled Trial Clinical Trial
Home-readiness after spinal anaesthesia with small doses of hyperbaric 0.5% bupivacaine.
Fifty-four patients were studied prospectively to evaluate home-readiness after a small dose (1 or 2 ml) of subarachnoid hyperbaric 0.5% bupivacaine. The block regressed significantly earlier in the 1 ml group than in the 2 ml group (p < 0.05). ⋯ We conclude that adequate surgical anaesthesia can be achieved with small doses of hyperbaric bupivacaine used for spinal anaesthesia. Although the sensory and motor block after 1 or 2 ml hyperbaric bupivacaine recovered within a reasonable time for day-case surgery, in some patients recovery of the ability to void was delayed to an undesirable extent.
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Randomized Controlled Trial Comparative Study Clinical Trial
Oxygen enrichment during emergence with the laryngeal mask--the 'T-bag' versus the T-piece.
We have compared the performance of a new oxygen enrichment device, the 'T-bag', with a T-piece during emergence from spontaneous breathing anaesthesia with the laryngeal mask airway. Thirty patients were randomly allocated to each group. Inspired and end-tidal gases were sampled from the proximal end of the laryngeal mask airway. ⋯ The mean inspired oxygen concentration was greater than 70% and the inspired carbon dioxide was less than 2 mmHg in both groups throughout emergence. There were no episodes of hypoxia (oxygen saturation < 92%). Both devices performed well, but the 'T-bag' offered advantages in terms of respiratory monitoring and ventilatory capability.
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Randomized Controlled Trial Clinical Trial
The influence of epidural administration of fentanyl infusion on gastric emptying in labour.
The effect of epidural infusions containing fentanyl on maternal gastric emptying in labour was examined using the rate of paracetamol absorption. Women were randomly allocated to receive one of two epidural infusions, bupivacaine 0.125% alone or bupivacaine 0.0625% with fentanyl 2.5 micrograms.ml-1 at a rate of 10-12 ml.h-1. Paracetamol 1.5 g was given orally to women after either 30 ml of the infusion solution had been given (mean time 2.5 h, study A) or 40-50 ml (mean time 4.5 h. study B). ⋯ There were no significant differences in maximum plasma paracetamol concentration, time to maximum paracetamol concentration and area under the concentration-time curve between the two groups for study A. In study B the time to maximum plasma paracetamol concentration was significantly delayed in women receiving > 100 micrograms fentanyl compared with controls (p < 0.05). We conclude that the dose of fentanyl that may delay gastric emptying when given by epidural infusion is greater than 100 micrograms.
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Acute intra-operative collapse of a lobe without apparent cause is rare. We report a case of transient bilobar atelectasis that developed without any apparent cause after a difficult tracheal intubation in a healthy young patient. ⋯ The characteristics of the lung collapse were atypical, suggesting either its reflex nature or acute reduction of lung volume owing to intubation-induced coughing. We present a review of the mechanisms of atelectasis.
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We describe the loss of function in the sciatic nerve after an uneventful sciatic nerve block using 25 ml of lignocaine 1% with adrenaline 1 in 200,000 in a patient receiving beta blocker drugs. Lack of pain on injection and complete regeneration of the nerve after 12 months in a patient with severe peripheral vascular disease led us to postulate ischaemic nerve damage as a mechanism of injury. Adrenaline-induced unopposed alpha-mediated vasoconstriction in a beta-blocked patient is suggested as a possible mechanism of peripheral nerve injury worthy of further investigation.