Anaesthesia
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Comparative Study
Response to a Valsalva manoeuvre before and after epidural block.
In pregnant patients at term the cardiovascular response to a Valsalva manoeuvre has been evaluated in the lateral and supine positions, before and after epidural block (T8-S5). There was no difference in the pattern of response under these four conditions. After epidural block, there was a tendency to a greater degree of hypotension and a slower recovery. In labour such repeated hypotension could account for the increase in fetal acidosis when the second stage of labour is conducted in the supine position.
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Equipment assembled for use by an accident team is described. The aim is to provide independent lightweight units that a medical practitioner can easily carry yet which will contain the essential items which he may need. ⋯ Compromise is inevitable which makes planning difficult particularly if action is seldom needed. Some schemes may need alternative equipment and individual preferences must also be taken into account.
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Following the report of the death of a patient concurrently taking fenfluramine, following routine general anaesthesia, a series of anaesthetised rabbits received injections of adrenaline or fenfluramine. There were abnormal electrocardiographic changes and phonocardiographic evidence of altered heart activity in both groups, but the changes seen with fenfluramine were greater in number and less readily reversed with beta blockers and resuscitative drugs. This evidence may support an interaction between halothane and fenfluramine in man, and it is suggested that the latter drug be discontinued for a week prior to anaesthesia for elective surgery.
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Clinical Trial Controlled Clinical Trial
The reliability of a linear analogue for evaluating pain.
A linear analogue for rating pain with 10, 15 and 20 cm lines is significantly less variable than a 5 cm line (mean error of 15 cm line is 0-19%, 95% confidence limits for the group +/- 2% and an inood correlation between repeated ratins of a recalled pain distant in time. The variance of the rating is significantly less than the repeated rating of a random mark. ⋯ Pethidine 150 mg intramuscularly had no significant effect, tested 30 minutes after the administration, on the accuracy or reproducibility of the analogue rating. A linear analogue seems a suitable method of recording the patient's opion of a severe pain such as that of labour.