British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Clinical study of a lignocaine-prilocaine cream to relieve the pain of venepuncture.
The efficacy of a topical anaesthetic formulation, EMLA 5% cream (Eutectic Mixture of Local Anaesthetics) in obtunding the pain produced by venepuncture, was determined in a double-blind randomized, cross-over study in 31 adult volunteers. Pain was registered on a 10-cm visual analogue scale. ⋯ Transient skin reactions (blanching, erythema and oedema) were observed with both formulations. These reactions were not found to be aggravated by repeated applications.
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Rat and mouse were utilized as models to study the spinal (subarachnoid) anesthetic effects of five commonly used local anaesthetic agents. Duration and frequency of motor and sensory blockade, and onset time were determined after injection of 5.0% lignocaine, 0.75% bupivacaine and 1.0% amethocaine to the same groups of rats with chronically implanted catheters in the lumbar subarachnoid space. ⋯ The relative potency and other characteristics of the compounds investigated were in agreement with results obtained in other species, including man. The techniques described may provide useful adjuncts to methods in larger animals for the evaluation of potential new spinal anaesthetic agents, and the study of various factors that may influence spinal anaesthesia.
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Randomized Controlled Trial Clinical Trial
Fentanyl by constant rate i.v. infusion for postoperative analgesia.
Fentanyl by continuous i.v. infusion (1.5 microgram kg-1 min-1 or 0.5 microgram kg-1 min-1) was compared with placebo infusion as an analgesic regimen for 24 h after hysterectomy. The drugs were infused using a new disposable device which required no external power source. All patients were allowed morphine i.m. if they experienced pain. Patients in the higher dose fentanyl group demanded less i.m. morphine and had better pain relief after operation, without important respiratory depression.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of midazolam, diazepam and placebo i.m. as premedication for regional anaesthesia. A randomized double-blind study.
In a randomized double-blind study, midazolam 0.1 mg kg-1 i.m. was compared with diazepam 0.2 mg kg-1 and placebo as premedication for patients undergoing urological interventions under spinal anaesthesia. The sedative and anxiolytic effects of midazolam were evident 5-10 min after administration, and were maximum between 30 and 90 min. ⋯ Amnesia was not seen in the patients receiving diazepam or placebo and, in contrast to midazolam, diazepam had almost no sleep-inducing effect. In a few patients, the depth of sleep achieved with midazolam 0.1 mg kg-1 was such that co-operation was impaired.
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Airway patency was explored in patients breathing spontaneously under deep halothane anaesthesia. Opening and closing of the airway was observed with a flexible bronchoscope looking proximally from the nasopharynx at the epiglottis and the tongue. With the occiput elevated at various angles the smallest angle of retroflexion of the neck necessary to open the airway was measured. ⋯ Cadaveric preparations of the upper airway were studied to assess the mechanisms involved in airway patency. The results indicate that the epiglottis and not the tongue is the main cause of obstruction of the upper airway. When methods are applied to displace the hyoid anteriorly, the airway will be cleared on most occasions.