Anaesthesia
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Two groups of insulin dependent diabetic subjects have been studied: six undergoing general surgical procedures and six undergoing hypothermic cardiopulmonary bypass surgery for coronary artery vein grafting. Intravenous glucose insulin mixtures were infused from the onset of surgery in both groups of patients, supplying 0.4 units of insulin per gram of glucose per hour, and 0.6 units of insulin per gram of glucose per hour in general and cardiac surgical patients respectively. ⋯ Five non-diabetic subjects who underwent surgery for coronary artery venous bypass grafting were also studied. They developed significant postoperative hyperglycaemia (5.0, SEM 0.2, mmol/litre pre-operatively, compared with 8.8, SEM 0.7, mmol/litre p less than 0.03 at 1 hour and 10.2, SEM 1.7, mmol/litre, p less than 0.02 at 4 hours after bypass terminated).
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Randomized Controlled Trial Comparative Study Clinical Trial
Epidural versus intramuscular fentanyl. Analgesia and pharmacokinetics in labour.
In a randomised double blind trial, 36 patients in the first stage of labour received either epidural or intramuscular fentanyl at the same time as the epidural test dose of bupivacaine. Analgesia was more rapid in onset and more complete in the epidural fentanyl group. ⋯ Plasma fentanyl concentrations showed wide interindividual variation, but after epidural fentanyl the peak occurred earlier. There was no correlation between analgesia and plasma fentanyl concentration, and epidural fentanyl produced superior analgesia but a systemic contribution to this effect cannot be ruled out.