Anaesthesia
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Randomized Controlled Trial Clinical Trial
Effects of intrathecal ketamine added to bupivacaine for spinal anaesthesia.
We prospectively studied 30 healthy female patients undergoing intracavitory brachytherapy applicator insertion for carcinoma of the cervix under spinal anaesthesia. Patients were randomly allocated to receive either intrathecal bupivacaine 10 mg alone or bupivacaine 7.5 mg combined with preservative-free ketamine 25 mg. Spinal block onset, maximum sensory level, duration of blockade, haemodynamic variables, postoperative analgesic requirements and adverse events were recorded. ⋯ Significantly more patients in the ketamine group had adverse events, such as sedation, dizziness, nystagmus, 'strange feelings' and postoperative nausea and vomiting. Although the addition of ketamine to spinal bupivacaine had local anaesthetic sparing effects, it did not provide extended postoperative analgesia or decrease the postoperative analgesic requirements. Moreover, the central adverse effects of ketamine limit its spinal application.
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Two case histories of pregnant women with Guillain Barré syndrome (acute demyelinating polyradiculoneuritis) are reported. The first required anaesthesia during the second trimester for a minor surgical procedure. ⋯ A review of the management of Guillain Barré syndrome in pregnancy discusses anaesthetic management, intensive care and the use of plasmapheresis and gamma-globulins. The care of pregnant women recovered from Guillain Barré syndrome is also discussed.