Anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Nalbuphine combined with midazolam for outpatient sedation. An assessment in fibreoptic bronchoscopy patients.
Forty patients who required day case fibreoptic bronchoscopy were sedated with either nalbuphine 0.2 mg/kg and midazolam 0.05 mg/kg (n = 20), or midazolam 0.05 mg/kg alone (n = 20). Extra midazolam was administered when required. ⋯ Patients who received nalbuphine had slightly higher carbon dioxide levels but respiratory rate and cardiovascular changes were similar in both groups. The addition of nalbuphine to midazolam improves the quality of sedation but prolongs the recovery time and increases the incidence of side effects.
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Three groups each of 20 patients scheduled to undergo operations on hand or forearm, received supraclavicular brachial plexus blocks with 25 ml lignocaine 1.5%. Patients in the control group did not suffer from pain and were not asked to do muscular exercise. Patients with acute trauma of the upper limb formed the pain group and showed significantly decreased latency for onset of analgesia, partial and complete muscle paralysis. ⋯ Onset of analgesia, partial and complete muscle paralysis was significantly more rapid than in both control and pain groups. Changes in the duration of block were not significant. It is concluded that pain and muscular exercise enhance the onset of brachial plexus blockade.
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Seventy-one adult patients (31 male, 40 female) who presented for surgery underwent orotracheal intubation with Portex Blue Line standard cuff disposable tubes (9-mm for males, 8-mm for females). The tracheal tube cuff was inflated by a trained assistant using a syringe and the initial cuff pressure measured; the minimum cuff pressure required to prevent respiratory gas leakage was also measured and the cuff pressure maintained above this pressure throughout the operation by means of the Cardiff Cuff Controller. ⋯ It is concluded that the present method of inflation may lead to gross overinflation of tracheal tube cuffs and that cuff pressure monitoring may be performed simply by means of an electropneumatic controller. The difference in minimum cuff pressure between males and females suggests that the difference in tracheal size between the sexes is greater than the 9-mm to 8-mm difference in tracheal tube size.
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Review Case Reports
Spinal haematoma following epidural analgesia. Report of a patient with ankylosing spondylitis and a bleeding diathesis.
A patient who developed an epidural haematoma with multifactorial aetiology (bleeding diathesis, ankylosing spondylitis, chronic alcoholism and acute pancreatitis) after epidural analgesia for pain relief is described. Our conclusion is that adequate laboratory screening of blood coagulation, including platelet count, should be carried out in this category of patient before attempted epidural blockade, the risks of which must be weighed against the benefits. The block should be allowed to wear off intermittently and repeated neurological assessment performed if an epidural catheter is used for repeated injections or for a continuous infusion of local anaesthetic. Neuroradiological examination should be carried out promptly if an epidural haematoma is suspected and surgical decompression performed without delay if the diagnosis is confirmed.