Anaesthesia
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Randomized Controlled Trial Clinical Trial
Low-dose bupivacaine-fentanyl spinal anaesthesia for transurethral prostatectomy.
We evaluated the effect of low-dose bupivacaine plus fentanyl administered intrathecally in elderly patients undergoing transurethral prostatectomy. Patients were randomly assigned to one of two groups. Group F received plain bupivacaine 4 mg with 25 micro g of fentanyl and sterile water to a total of 1.5 ml, and Group B received only 0.5% plain bupivacaine 7.5 mg for spinal anaesthesia. ⋯ The mean level of motor block was higher and the duration of motor block was longer in Group B (p < 0.0001). Hypotension and shivering were significantly more common in Group B (p < 0.05). The addition of fentanyl 25 micro g to plain bupivacaine 4 mg provides adequate analgesia for transurethral prostatectomy with fewer side-effects in elderly patients when compared with the conventional dose of bupivacaine.
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Sexual hallucinations have been reported since the introduction of chloroform. Newer agents such as midazolam and propofol appear particularly prone to producing them. ⋯ Other individuals, including doctors, have used the amnesic effects of midazolam and other drugs to sexually assault victims. Clinicians should be aware of the risks to which they may inadvertently expose themselves if these drugs are not used carefully.
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The AAI index, the BIS index and end-tidal concentration during wash in and wash out of sevoflurane.
The bispectral index (BIS), auditory evoked potential index (AAI) and the end-tidal sevoflurane concentration were studied during induction and emergence in 10 ASA I-II patients. Both during 'wash-in' and 'wash-out' of sevoflurane, the AAI and BIS indices show huge variability and an overlap of indices between awake and not responding to command. ⋯ Mean (range) BIS was 85 (73-98) and 48 (10-83) awake and unconscious, respectively, and mean AAI index was 71 (43-99) and 21 (4-85), respectively. This study demonstrates the difficulties of using processed EEG variables in real time in a clinical situation of non-steady state pharmacodynamics.