Anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Forum. A comparison between the midline and paramedian approaches to the extradural space.
A prospective, randomised study was devised to compare the midline and paramedian approaches to the extradural space in women during labour. The two approaches were equally successful with respect to catheter insertion and analgesia and had a similar incidence of complications, although the paramedian approach caused patients more discomfort. Since only 2 ml of 1% lignocaine with adrenaline were infiltrated prior to insertion of the Tuohy needle, a greater volume of the local anaesthetic may reduce the discomfort of using the paramedian approach.
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Randomized Controlled Trial Clinical Trial
The analgesic effect of a low dose of alfentanil.
The effect of a single small dose of alfentanil (6 micrograms/kg) on postoperative pain was compared with saline using a double blind study. Pain was assessed using a linear analogue scale and shown to decrease at 2, 5 and 10 minutes after injection of alfentanil (p less than 0.01). ⋯ There were no changes in pain or PE'CO2 in the control group throughout the study. Intravenous alfentanil given to patients in pain provides quick effective analgesia for a short period of time, but respiratory depression may occur.
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Comparative Study
Electromyography in anaesthesia. A comparison between two methods.
Two instruments measuring evoked compound muscle action potentials (EMG) produced by train of four stimulation of the ulnar nerve were compared. The neuromuscular transmission section of a Datex Anaesthesia and Brain Monitor (ABM), which utilises an integration technique to measure the EMG, and the Medelec MS6 , by which amplitude of the EMG was recorded and measured were attached to the same electrodes placed over adductor pollicis. ⋯ The changes in neuromuscular transmission measured by the two methods correlated well, with no statistically significant difference in results. The ABM provides a simple and accurate automatic measurement of evoked EMG for use in the study of neuromuscular transmission.
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Comparative Study
An assessment of the Humphrey ADE anaesthetic system in the Mapleson A mode during spontaneous ventilation.
The Humphrey ADE anaesthetic breathing system in the Mapleson A mode has been compared with the Magill system in spontaneously breathing conscious volunteers and anaesthetised patients. In the latter, rebreathing occurred at a significantly lower fresh gas flow with the ADE system than when the Magill system was used (mean 45.6 ml/kg/minute and 56.5 ml/kg/minute respectively). There was no significant difference between the fresh gas flow at which rebreathing occurred in conscious volunteers.
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The problem of sedating patients requiring prolonged controlled ventilation has recently received considerable attention. Various therapeutic regimes are available and there appears to be a general move away from the use of muscle relaxants towards sedative drugs. ⋯ However, enthusiasm for its use must be tempered by recent reports of cardiovascular collapse following its administration. We wish to report a case of intracranial hypertension following the use of phenoperidine in a ventilated patient with a severe head injury.