Der Anaesthesist
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Randomized Controlled Trial Clinical Trial
Bupivacaine in caudal anaesthesia for anal surgery.
A study is described of 100 consecutive patients given a caudal block for anal surgery using either 0.25% or 0.5% bupivacaine with adrenaline. The initial success rate was 91%, and a further 8% achieved only a unilateral block. Satisfactory anaesthesia in these cases could be achieved with either a second caudal block or unilateral infiltration of the un-anaesthetized half of the surgical field with lignocaine. ⋯ No serious complications were observed. Post-operative analgesia lasted between 10 and 12 h after the block and this compared favourably with the results from two small control groups given either a general anaesthetic or a lignocaine caudal block in which the patients required analgesics 2,5 and 4,5 h respectively from the start of the anaesthetic procedure. In the bupivacaine treated patients there was a significant reduction in the need for post-operative analgesics throughout the whole postoperative period.
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Hormonal changes, occurring during electrocoagulation of the Gasserian ganglion under neuroleptanalgesia, and the effects of intravenous administration of pindolol 0.4 mg on these changes were investigated in two groups of 10 and 12 patients of advanced age. At the end of the operation there were marked increases of the concentrations of catecholamines, a rise of the plasma cortisol and a fall of the serum insulin. The administration of the beta-adrenergic blocking agent did not induce any statistically significant changes of the determined hormones compared to the control group.
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We report a case of malignant hyperthermia in a man of 41 years during his 13th general anaesthesia. All previous anaesthetics were quite normal. ⋯ The combined use of suxamethonium and halothane might have caused the development of malignant hyperthermia. As a concept of the aetiology of the syndrome the case history indicates that it may be stress-related.