British journal of anaesthesia
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In nine patients, with preoperative ICP monitoring, anaesthesia was induced with thiopentone 5 mg kg-1 given over 1 min, followed by pancuronium 0.1 mg kg-1. After manual hyperventilation with nitrous oxide and oxygen for 3 min they were given thiopentone 2.5 mg kg-1 over 30 s (phase 1); 30 s later laryngoscopy was performed and topical analgesia administered to the larynx. Endotracheal intubation was performed 1 min after spraying the cords (phase 2). ⋯ Although there was a significant decrease (P less than 0.05) in MAP at the end of the second dose of thiopentone, there were no other significant changes in ICP, MAP or PaCO2 throughout the study. In two patients there were transient decreases in cerebral perfusion pressure to less than 60 mm Hg. Although MAP increased in five of the patients during laryngoscopy and intubation, there was no increase in ICP, showing that the MAP was still within the autoregulatory limits.
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The action of droperidol on cardiac vagal efferents was studied in anaesthetized dogs. Droperidol in cumulative doses (0.125, 0.25 and 0.5 mg kg-1 i.v.) inhibited cardiac vagal discharge, shifted pressure-response curves to lower activities, increased heart rate, and decreased arterial pressure slightly. The effects on vagal discharge and heart rate reached their maxima at 0.25 mg kg-1 as a further increase in the dose had no additional effect. ⋯ After pretreatment with atropine, droperidol had no effect on heart rate. Thus, droperidol inhibits central vagal drive independently of arterial pressure. This central vagolytic action seems to be the main cause for the positive chronotropic effect of droperidol.
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Randomized Controlled Trial Clinical Trial
Extradural morphine and pain relief following episiotomy.
One hundred and fifty obstetric patients, who had received intrapartum extradural analgesia with bupivacaine, and had required episiotomy, were given a final postpartum injection of preservative-free morphine in saline, or saline alone, on a double-blind basis. The degree of perineal analgesia was assessed by linear analogue scale at intervals up to 36 h, and oral analgesic requirements were recorded. A significant degree of analgesia was obtained for up to 12 h with morphine 2 mg, compared with saline. Increasing the dose to 4 mg increased the occurrence of side-effects, and was associated with less marked analgesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Subarachnoid anaesthesia with 0.5% bupivacaine: effects of density.
The effects of subarachnoid administration of 0.5% bupivacaine 4 ml in 8%, 5% or 0% glucose were investigated in a double-blind study in 30 women undergoing laparotomy through a lower abdominal incision. The onset time for maximum segmental spread of analgesia was 10-15 min for all solutions. Cephalad segmental spread of analgesia was three to four segments higher with the hyperbaric solutions (T4-5 v. ⋯ Duration of motor blockade generally decreased with increasing glucose concentration, only the hyperbaric solutions providing useful for abdominal surgery, with a duration of 1-1.5 h. Anaesthesia (halothane) was required in seven of 10 patients in the glucose-free group and in five of 20 in the hyperbaric groups. No occurrence of "post-spinal headache" was recorded in the study.