Anaesthesia
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Comparative Study
Epidural versus general anaesthesia for elective caesarean section. Effect on Apgar score and acid-base status of the newborn.
Elective Caesarean section deliveries over a 5-year period were studied to compare the effect of epidural block with general anaesthesia on the condition of the infant at birth. The Apgar score and umbilical arterial acid-base status were used as determinants of the latter. Epidural block was used in 139 (22.8%) mothers while 471 (77.2%) were performed under general anaesthesia. ⋯ The findings suggest that general anaesthesia, rather than asphyxia or aortocaval compression, is responsible for most of the depressed infants born by elective Caesarean section. This may involve over 20% of babies delivered in this manner, so greater use of epidural block for elective Caesarean section is recommended. Further investigations are required to improve results with general anaesthesia.
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A case of total obliteration of the axillary artery after axillary block is presented. This resulted from an accidental intramural injection of local anaesthetic (mepivacaine 1%, 40 ml, with adrenaline 1:200,000). ⋯ The diagnosis was made by palpation of the peripheral pulse and by comparison between the skin temperatures of each arm. The thrombosed part of the artery was successfully reconstructed with an autologous saphenous vein graft.
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Randomized Controlled Trial Clinical Trial
Opioid supplementation during propofol anaesthesia. The effects of fentanyl or alfentanil on propofol anaesthesia in daycase surgery.
Sixty patients of ASA grade 1 or 2 who presented for minor daycase gynaecological or urological procedures were randomly allocated to three groups. Group A received fentanyl 1 microgram/kg and Group B alfentanil 5 micrograms/kg prior to induction. ⋯ The pre-induction administration of fentanyl or alfentanil was not found significantly to affect either the doses of propofol required for induction or maintenance or the quality of anaesthesia compared with propofol alone. These results suggest that for minor outpatient procedures under general anaesthesia, the concomitant use of a short-acting opioid confers no benefits over propofol with oxide and oxygen alone.