Anaesthesia
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Randomized Controlled Trial
A randomised controlled trial of phenylephrine and noradrenaline boluses for treatment of postspinal hypotension during elective caesarean section.
Phenylephrine & noradrenaline show similar incidence of bradycardia when used for postspinal hypotension prophylaxis during Caesarean section.
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“Inhalational anaesthetic agents are chlorofluorocarbons, ‘greenhouse gases’ that have between 349 (sevoflurane) and 3714 (desflurane) times the global warming potential over a 20 year time horizon of carbon dioxide (isoflurane 1401), equivalent to driving a car 18 (sevoflurane) to ~350 miles (desflurane) per hour of anaesthetic use (isoflurane 30 miles); these figures do not account for the additional carbon cost of heating desflurane vaporisers. Together with nitrous oxide, inhalational anaesthetic agents contribute ~2.5% of the 22.8 million tonnes of carbon dioxide equivalents the NHS produces annually.” - White
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Randomized Controlled Trial
Assessment of gastric emptying of maltodextrin, coffee with milk and orange juice during labour at term using point of care ultrasound: a non-inferiority randomised clinical trial.
Labouring women have been shown to have slower gastric emptying than non-pregnant subjects, and this argument is sometimes used to recommend fasting guidelines such as nil-by-mouth during labour. We performed a parallel group, randomised non-inferiority trial, comparing gastric emptying of 450 ml isocalorically-adjusted maltodextrin, coffee with milk or pulp-free orange juice, with 18 women in each group. The women were initially fasted for 2 h for clear fluids, 6 h for a light meal and 8 h for a high fat or high protein meal. ⋯ The estimated gastric residual volume was lower than baseline from 90 min after drinking maltodextrin. In labouring women, maltodextrin is cleared from the stomach faster than coffee with milk and orange juice. Gastric emptying depends on other factors besides the caloric load and volume of the drink.
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We investigated whether low melting point phase-change waxes could be incorporated into emergency drug transport bags to attenuate the known temperature extremes their contents can be exposed to. We exposed two custom-made hollow-walled drug containers placed within a pair of drug transport bags to three day/night cycles including periods of direct radiant sunlight. The wall cavities of one contained air, whereas those of the other contained a paraffin wax (melting point of 44-46 °C) with a high latent heat of fusion (until fully melted, its temperature does not increase further). ⋯ Even when they did so, their temperature was attenuated to 40.3 °C, despite an ambient air temperature of > 40 °C for 6.4% of the time (peak 46.9 °C) and a bag surface temperature of > 40 °C for 17.2% of the time (peak 64.4 °C). In contrast, the ampoule temperature in the air cavity container exceeded 40 °C for 17.1% of the time (peak 54.1 °C). The latent heat of fusion of phase-change materials may be exploited in the design of drug transport bags to mitigate any temperature changes in the drugs stored within them.