Anaesthesia
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Randomized Controlled Trial Clinical Trial
Reduction of pain on injection of etomidate.
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The epidural space pressure in the lumbar region was monitored and recorded in 21 full term pregnant patients, before and during labour and 6-12 hours postpartum, in different positions. The pre-labour epidural pressure was found to be above atmospheric in all patients, being highest when supine, and lowest in the lateral position. Three patients with twin pregnancy showed a greater rise in epidural space pressure in the supine position even with the use of lateral tilt, compared with patients with single fetus pregnancy. ⋯ With established epidural block, and the parturient unaware of a contraction, such a rise was minimal, and was replaced by a drop in pressure in patients with a single fetus who developed loss of muscle power. The magnitude of the drop in the epidural space pressure immediately after delivery was found to be related to the duration of labour and to the mode of delivery. Epidural pressures measured 6-12 hours after delivery were comparable in all patients.
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Randomized Controlled Trial Comparative Study Clinical Trial
Fentanyl and the metabolic response to gastric surgery.
The effect of the supplementation of nitrous oxide-oxygen anaesthesia with either 50 micrograms fentanyl/kg body weight or 0.5-1.0% halothane on the metabolic and hormonal response to gastric surgery was investigated in 16 patients. Those patients who received fentanyl showed a significant decrease (p less than 0.05) in the hyperglycemic response to surgery after 30 and 90 minutes and a significant decrease (p less than 0.05) in the plasma cortisol response after 30 minutes. ⋯ This required the intravenous administration of naloxone and careful supervision in the early postoperative period. It is concluded that the transient metabolic and endocrine benefits produced by fentanyl do not compensate for the severe respiratory problems postoperatively and thus 'high-dose fentanyl' cannot be recommended for upper abdominal surgery.
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The effects of precurarisation, with small doses of pancuronium, curare or gallamine, on the neuromuscular blockade following suxamethonium, 1 mg/kg, were studied using train-of-four stimulation. The duration of the block was reduced by pretreatment with d-tubocurarine and gallamine but increased with pancuronium. The degree of competitive neuromuscular blockade, both after administration of the precurarising dose and at full recovery from suxamethonium was mild and was insufficient to be a cause of postoperative muscle weakness.