Anaesthesia
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Clinical Trial
Haemodynamic effects of intravenous nimodipine following aneurysmal subarachnoid haemorrhage: implications for monitoring.
Nimodipine is widely used in patients with aneurysmal subarachnoid haemorrhage for the prevention and treatment of delayed ischaemic neurological deficits. Intravenous nimodipine has significant vasodilatory properties and may compromise the achievement of haemodynamic targets in patients who receive hypertensive hypervolaemic haemodilution therapy. ⋯ Formal haemodynamic assessment in these patients showed widely varying haemodynamic variables, with differences in the need for inotropic and vasopressor therapy. We conclude that optimal haemodynamic management in this subgroup of patients will require the use of pulmonary artery catheterisation.
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The Sonomatic Confirmation of Tracheal Intubation (SCOTI, Penlon, UK) device was evaluated in the laboratory with cut and uncut tracheal tubes and in 50 adult patients who underwent tracheal and oesophageal intubation with uncut tracheal tubes. We could not configure the SCOTI reliably with cut tracheal tubes. In the clinical study using uncut tubes the SCOTI identified all oesophageal intubations, but was only able to identify 84% (95% CI: 73.8-94.2%) of tracheal intubations. We recommend caution in using this device and further independent evaluation to determine its reliability.
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A case of complete uterine rupture during a trial of labour in which epidural analgesia was used is described. The pain of uterine rupture was not masked by the addition of fentanyl 25 micrograms to bupivacaine 0.25% 6 ml but was relieved by bupivacaine 0.375% 6 ml.
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In order to evaluate the general public's knowledge of postoperative pain and its management, a simple questionnaire was devised and sent out to five general practices in Scotland and Yorkshire. Questionnaires were completed voluntarily by 529 people attending their general practitioner for reasons not related to surgery. Five hundred and fifteen completed questionnaires were analysed. ⋯ Attitudes to pain varied greatly and confirm the findings of other surveys that amongst the general public there is little or no understanding of the nature of postoperative pain or of the methods available to treat it. Despite the published literature, the public have a high degree of confidence in the ability of doctors and nurses to treat such pain. Widespread public and professional education is required before further improvements can be made to such a universal and basic clinical problem.