Anaesthesia
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Case Reports
Radicular acute pain after epidural anaesthesia with the technique of loss of resistance with normal saline solution.
Epidural anaesthesia using the loss of resistance to saline technique, without air, was successfully performed in a 65-year-old man scheduled for elective vascular surgery of the right leg. Epidural catheterisation was uneventful. ⋯ After excluding other causes, the spontaneous entry of air through the Tuohy needle was thought to be the most likely explanation for this complication. The patient recovered uneventfully.
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Randomized Controlled Trial Comparative Study Clinical Trial
Peri-operative tolerance to large-dose 6% HES 200/0.5 in major urological procedures compared with 5% human albumin.
We studied the long-term efficacy and safety of medium-molecular-weight hydroxyethyl starch (HES) administered in doses above 20 ml.kg-1 during major blood replacement therapy. Blood replacement for 50 patients used 6% HES 200/0.5 (HES group) or 5% albumin (ALB group) and additional blood components according to a defined protocol. We compared safety, efficacy and costs in 4 peri-operative days. ⋯ Blood loss (3810 (1632) ml (HES group) and 3455 (1733) ml (ALB group)) and the requirement for blood components was comparable. Costs were reduced by 35% (p < 0.05) in the HES group. We conclude that using 6% HES 200/0.5 as the only colloid for treatment even of large blood loss is a safe and economic alternative to albumin.
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Clonidine has proved to be a clinically useful adjunct in clinical anaesthetic practice as well as in chronic pain therapy because it has both anaesthetic and analgesic-sparing activity. The more selective alpha-2 adrenoceptor agonists, dexmedetomidine and mivazerol, may also have a role in providing haemodynamic stability in patients who are at risk of peri-operative ischaemia. The side-effects of hypotension and bradycardia have limited the routine use of alpha-2 adrenoceptor agonists. ⋯ We discuss the pharmacology of alpha-2 adrenoceptors and their therapeutic role in this review. The alpha-2 adrenoceptor agonists are agonists at imidazoline receptors which are involved in central blood pressure control. Selective imidazoline agonists are now available for clinical use as antihypertensive agents and their pharmacology is discussed.
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Randomized Controlled Trial Comparative Study Clinical Trial
Clinical efficacy and pharmacokinetics of 1% ropivacaine and 0.75% bupivacaine in peribulbar anaesthesia for cataract surgery.
Peribulbar anaesthesia with 1% ropivacaine and 0.75% bupivacaine, both with hyaluronidase, was assessed in a prospective, randomised, double-blind study of 100 patients undergoing cataract surgery. Pharmacokinetic data were obtained from 22 subjects. Akinesia of the globe developed slightly more rapidly in the ropivacaine group, but this difference was only statistically significant at 2 min after injection of the local anaesthetic. ⋯ The dose-adjusted maximum concentration of ropivacaine was approximately twice that of bupivacaine with significantly higher values of the area under the concentration-time curves. No drug-related adverse effects were observed. We conclude that there are no clinically significant differences in the quality of the sensory and motor block between 1% ropivacaine and 0.75% bupivacaine when used for peribulbar anaesthesia.