British journal of anaesthesia
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An infusion of 0.1% trimetaphan was administered to eight cats with artificially increased intracranial pressure (ICP) in order to decrease their mean arterial pressure (MAP) from 121 +/- 9.5 (SEM) to 58 +/- 4.6 mm Hg in less than 1 min. All cats developed an increase in intracranial pressure (ICP) (from 16 +/- 1.4 to 23 +/- 3.2 mm Hg) accompanied by a partial rebound in MAP. ⋯ In nine of the 12 cats with an ICP increase, that increase was initiated before the partial MAP rebound. We conclude that trimetaphan causes clinically significant ICP increases in cats with increased ICP, that partial rebound in MAP frequently exacerbates these increases in ICP, and that rapid induction of hypotension tends to increase the frequency with which trimetaphan increases ICP.
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The plasma concentration of hepatic glutathione S-transferase (GST) was measured in matched groups of patients who received halothane, enflurane or isoflurane anaesthesia for elective minor surgery. The GST concentrations increased significantly at 3 h after anaesthesia in patients who received halothane or enflurane, but not in patients who were given isoflurane. ⋯ The small but significant increases in GST concentrations in patients receiving halothane or enflurane suggests an impairment of hepatocellular integrity following the administration of these anaesthetics. In contrast, isoflurane anaesthesia did not appear to be associated with this effect.
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Randomized Controlled Trial Clinical Trial
Effect of adrenaline on extradural anaesthesia and plasma bupivacaine concentrations during caesarean section.
The effect of adrenaline on the efficacy of extradural block and plasma bupivacaine concentrations was investigated in women undergoing elective (n = 40) and emergency (n = 40) Caesarean section. Patients were randomly allocated within these two groups to receive 0.5% bupivacaine 20 ml either plain or with adrenaline 1 in 200,000, as a single fractionated extradural injection. The elective plain group needed significantly more supplementary analgesia compared with the other three groups (P less than 0.05). ⋯ In the emergency group, there were no significant differences in plasma bupivacaine concentrations between the plain and adrenaline subgroups. Maximum plasma concentrations correlated significantly (P less than 0.0001) with dose of bupivacaine (mg kg-1). It is concluded that extradural adrenaline does not usefully reduce systemic absorption of 0.5% bupivacaine, but may improve its efficacy in extradural anaesthesia for elective Caesarean section.
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Randomized Controlled Trial Clinical Trial
Posture and post-spinal headache. A controlled trial in 80 obstetric patients.
Eighty obstetric patients receiving subarachnoid anaesthesia for second and third stage procedures, excluding Caesarean section, were studied. They were randomly allocated postpartum to either 24 h bed rest or early (6 h post spinal) mobilization. ⋯ There was a significantly greater incidence of severe spinal headaches in the "bed-rest" group and three patients in this group required blood patch treatment for their headache. Early mobilization is, therefore, the recommended management after spinal anaesthesia for these types of obstetric procedure.