Anaesthesia
-
Randomized Controlled Trial Clinical Trial
The influence of intrathecal fentanyl on the characteristics of subarachnoid block for caesarean section.
Forty healthy parturients scheduled for elective Caesarean section were randomly allocated to receive either 0.3 ml 0.9% saline (control group, n = 20), or 15 micrograms (0.3 ml) fentanyl (treatment group, n = 20) added to 2.5 ml 0.5% hyperbaric bupivacaine given intrathecally in the sitting position. A sensory block to T4 was achieved after 6.5 min in those who received fentanyl compared to 8.0 min in the control group; this was not significantly different. The highest level of sensory block achieved in both groups was similar. ⋯ Regression of anaesthesia to T12 took longer (184 vs 156 min, p < 0.05) in those who received fentanyl but this did not affect the total requirement of morphine in the first 24 h after operation. There was no difference in the incidence of side effects in the mother and no adverse effects were detected in the baby. The results indicate that adding 15 micrograms fentanyl to hyperbaric bupivacaine for spinal anaesthesia markedly improves intra-operative anaesthesia for Caesarean section.
-
Clinical Trial Controlled Clinical Trial
Controlled ventilation using isoflurane with an in-circle vaporiser.
We studied 19 patients anaesthetised for routine surgery using isoflurane delivered from a Komesaroff vaporiser mounted within a circle system. Their lungs were ventilated using a Penlon Nuffield ventilator attached to the circle system by a trunk of tubing. Fresh gas flow rates of 1, 2 or 31.min-1 were used. The inspired agent concentration was measured using a Datex Ultima multigas analyser and was found to be stable and easily controlled.
-
Atrial fibrillation is a common arrhythmia frequently seen in surgical patients. The onset of new atrial fibrillation during the peri-operative period is less common. There are many possible precipitating factors, although volatile agents themselves may have an antifibrillatory action. ⋯ Alternatively, anti-arrhythmic drugs can be used to achieve cardioversion. In patients with rapid, chronic atrial fibrillation or those refractory to cardioversion, priority is given to control of the ventricular rate. Thrombo-embolism is a significant risk if atrial fibrillation is paroxysmal or persists for more than 48 h.