Anaesthesia
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Epidural abscess is a well-recognised but rare complication of epidural catheter placement. We have found only five previous reports of epidural abscess from noncatheter-related administration of steroids and/or local anaesthetic. We describe a further case which led to critical illness and emphasise the association between diabetes mellitus and epidural infection.
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Randomized Controlled Trial Comparative Study Clinical Trial
Propofol anaesthesia and vomiting after myringoplasty in children.
To determine whether propofol anaesthesia reduces the incidence of nausea and vomiting after ear surgery, 40 children aged 4-16 years were randomly assigned to receive either propofol or inhalational anaesthesia. Children in the propofol group had anaesthesia induced with propofol and maintained with propofol-nitrous oxide and those in the inhalational group had anaesthesia induced with thiopentone and maintained with isoflurane-nitrous oxide. Nausea and vomiting were recorded for 24 h after surgery and metoclopramide was offered to children who vomited more than twice. ⋯ The incidence of vomiting was lower in the propofol group during the first 2 h after surgery (0% and 25% propofol and inhalational groups, respectively) (p < 0.05) but was similar at all other time intervals. Rescue anti-emetic was given to two (10%) and eight (40%) children in the propofol and inhalational groups, respectively (p < 0.05). We conclude that propofol anaesthesia alone is not an effective means of preventing vomiting after middle ear surgery in children.
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Randomized Controlled Trial Clinical Trial
Laryngeal mask lubrication. A comparative study of saline versus 2% lignocaine gel with cuff pressure control.
We compared 2% lignocaine gel with saline as a lubricant for the laryngeal mask airway in 126 patients receiving positive pressure ventilation in whom cuff pressures were limited to 60 cmH2O and peak airway pressures to less than 17 cmH2O. The incidence of sore throat was similar for both groups and there were no emergence problems. ⋯ Lignocaine gel is an unsuitable lubricant for the laryngeal mask airway. Cuff pressure limitation to 60 cmH2O does not necessarily impede ventilation and may be an important factor in reducing emergence and postoperative complications.
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To investigate current concerns that potent opioid drugs, such as fentanyl, used for labour regional analgesia may affect neonatal status, maternal and umbilical plasma concentrations of fentanyl and bupivacaine at delivery were measured in 40 nulliparous patients receiving low-dose combined spinal epidural analgesia. Neonatal assessments included Apgar scores, umbilical blood gases and neurobehavioural tests. All maternal and umbilical venous plasma concentrations were low. ⋯ Mean umbilical vein/maternal fentanyl ratios were 1.12 for total drug and 1.20 for free drug and values were unrelated to the last epidural bolus to delivery interval (r = 0.12, p = 0.49). There were no correlations between Apgar scores, umbilical blood gases or neurobehavioural scores and umbilical venous concentrations of either fentanyl or bupivacaine. The dose of fentanyl used for ambulatory combined spinal epidural analgesia would appear to have a negligible effect on neonatal condition.
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Clinical Trial
Patient-maintained propofol sedation. Assessment of a target-controlled infusion system.
We have developed a system which allows patients to operate a target-controlled infusion of propofol to provide sedation and we have studied its use in 36 unpremedicated patients undergoing local and regional anaesthetic procedures lasting 10-280 min. An intravenous propofol infusion was started at a target plasma level of 1 microgram.ml-1. The patient was able to increase the target propofol concentration in 0.2- microgram.ml-1 increments by pressing a demand button. ⋯ The target-controlled infusion system bias was-47% and the inaccuracy was 48%. Patient satisfaction was high and 89% said that they would definitely use the technique again. This technique combines the benefits of target-controlled infusion with patient-controlled feedback and produces safe intra-operative sedation.