Anaesthesia
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Randomized Controlled Trial Clinical Trial
The effect of low-dose ketamine on fentanyl-induced respiratory depression.
This study evaluated if adding low-dose ketamine to fentanyl could offer a haemodynamically stable drug combination with little respiratory side-effects. Eight healthy, consenting male volunteers received in a random, cross-over and double-blind fashion both fentanyl 2 micrograms.kg-1 + ketamine 0.25 mg.kg-1 and fentanyl 2 micrograms.kg-1 + placebo. The fentanyl and placebo reduced minute ventilation, alveolar ventilation and oxygen consumption (p < 0.05), with little effect on haemodynamics. ⋯ Both treatments decreased oxygen saturation and arterial oxygen pressure similarly. Ketamine thus attenuated the fentanyl-induced reduction in ventilation without preventing the decrease in blood oxygenation. In conclusion, combining low-dose ketamine to fentanyl offers no benefits in terms of preventing respiratory depression.
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Randomized Controlled Trial Clinical Trial
Regional analgesia in early active labour: combined spinal epidural vs. epidural.
We randomly allocated 93 women in early active labour and requesting epidural analgesia to receive either epidural (n = 48) or combined spinal-epidural analgesia (n = 45). For epidural analgesia 15 ml of bupivacaine 0.1% with 75 micrograms of fentanyl were injected into the epidural space. For combined spinal-epidural analgesia 1 ml of bupivacaine 0.25% with 25 micrograms of fentanyl were injected into the subarachnoid space. ⋯ The PCEA machine failed completely twice and temporarily many times. We conclude that the combined spinal-epidural technique confers no advantages in early active labour. Also, a lightweight PCEA pump needs to be more reliable before we can recommend its use.
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A postal survey of the practice of thoracic epidural analgesia was sent to 275 hospitals in the United Kingdom. Responses were received from 70% of hospitals. Informed consent is rarely adequately obtained, with only 28% of respondents mentioning even the most common complications. ⋯ The majority of epidurals (63%) are nursed in intensive care units postoperatively. Properly funded pain management teams, at present unusual, would facilitate ward-based epidural management and release intensive care resource. A central register of epidural complications is required to provide valuable evidence for the optimum practice of thoracic epidural analgesia.
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Case Reports Randomized Controlled Trial Clinical Trial
The effect of the addition of adrenaline to pethidine for patient-controlled epidural analgesia after caesarean section.
We have investigated the addition of adrenaline to pethidine for patient-controlled epidural analgesia after elective Caesarean section. In a randomised, double-blind study, patients received patient-controlled epidural analgesia for 24 h using pethidine 5 mg.ml-1 with adrenaline 5 micrograms.ml-1 (adrenaline group, n = 40) or pethidine 5 mg.ml-1 without adrenaline (plain group, n = 38). ⋯ Patients in the adrenaline group had higher visual analogue scale scores for nausea at 2 h and 24 h and higher scores for pruritus at 2 h compared with the plain group. Addition of adrenaline to pethidine for patient-controlled epidural analgesia does not appear to have significant clinical advantages.