Anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of the effect of EMLA and semicircular subcutaneous anaesthesia in the prevention of tourniquet pain during plexus block anaesthesia of the arm.
In 54 patients who were to undergo surgery of the upper extremity in plexus block anaesthesia the effect of 5 g EMLA (group E) on tourniquet pain was examined and compared with the effect of a semicircular subcutaneous anaesthesia using 10 ml 0.25% bupivacaine (group B) or 10 ml 1% mepivacaine (group M). Among the patients with satisfactory brachial plexus analgesia allowing for surgery (n = 51), the incidence of tourniquet pain was not significantly different between groups E, M and B. Notably, there was no significant difference in the time of tourniquet application. We conclude that topical application of EMLA is as effective as a semicircular subcutaneous anaesthesia with mepivacaine or bupivacaine in the prevention of tourniquet pain during brachial plexus anaesthesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Postoperative respiratory function in children after abdominal surgery. A comparison of epidural and intramuscular morphine analgesia.
Thirty children undergoing urological and abdominal surgery were entered into a randomised trial comparing the effects of epidural and intramuscular morphine on postoperative respiratory function. The forced vital capacity and the forced expired volume in 1 s were measured before and 6 h after surgery and on each of the following seven days. Significant decreases (p < 0.01) in forced vital capacity and forced expired volume in 1 s were seen after surgery. ⋯ There were no statistically significant differences between the two groups during the study with respect to forced vital capacity and forced expired volume in 1 s. The quality of analgesia was better in the epidural morphine group than in the intramuscular morphine group. The incomplete recovery of pulmonary function suggests that pain is not the only cause of postoperative respiratory changes in these patients.
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Review Case Reports
Recurrent respiratory depression after total intravenous anaesthesia with propofol and alfentanil.
Since first commented upon by Lamarche in 1984, several cases of recurrent respiratory arrest after alfentanil infusions have been reported. In all these cases the alfentanil infusions have been used to supplement conventional anaesthetic techniques with nitrous oxide and/or inhalational agents and in most cases rather high total alfentanil doses have been administered. We have seen two cases of severe recurrent respiratory depression in healthy patients after relatively minor procedures performed under total intravenous anaesthesia with propofol-alfentanil infusions, air-oxygen ventilation and muscle relaxation, where the alfentanil doses administered were quite small. These cases are presented in detail and compared within a tabulated presentation with the earlier published cases of alfentanil-related recurrent respiratory depression.
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Randomized Controlled Trial Clinical Trial
Clinical utility of EEG parameters to predict loss of consciousness and response to skin incision during total intravenous anaesthesia.
We studied 30 female patients undergoing elective surgery, to assess the reliability of electroencephalogram spectral edge frequency and median frequency to predict loss of consciousness and movement in response to skin incision during total intravenous anaesthesia. Each patient received a different combination of propofol (1, 2, 3, 4, 5 or 6 micrograms.ml-1) and sufentanil (0.1, 0.2, 0.3, 0.5 or 1.0 ng.ml-1) target concentrations for induction of anaesthesia using target controlled infusions, assigned randomly. ⋯ The probabilities of 50% and 95% no response for spectral edge frequency were 13.4 Hz and 6.8 Hz, respectively. The variability of the data limited the predictive value, so that spectral edge frequency was a poor predictor and median frequency was no predictor of response in the individual patient during total intravenous propofol/sufentanil anaesthesia.
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Randomized Controlled Trial Clinical Trial
Influence of pre-anaesthetic medication on target propofol concentration using a 'Diprifusor' TCI system during ambulatory surgery.
The effects of pre-anaesthetic medication on target propofol concentration, induction dose, time to induction, and discomfort on infusion were studied in 45 female patients undergoing ambulatory gynaecological procedures using 'Diprifusor' target controlled infusion of propofol. The patients were randomly allocated to receive either no premedication (group 1) or premedication with diazepam alone (group 2) or in combination with alfentanil (group 3). ⋯ There were no significant between-group differences in discomfort on infusion or target concentration during maintenance. For short ambulatory procedures, the recommended initial target concentration of propofol is 4 micrograms.ml-1 in premedicated and 6 micrograms.ml-1 in unpremedicated patients.