British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Effects of posture and baricity on spinal anaesthesia with 0.5% bupivacaine 5 ml. A double-blind study.
In four groups of 10 patients, 0.5% bupivacaine 5 ml was used in spinal anaesthesia for gynaecological surgery. Group 1 received plain solution in the sitting position, group 2 plain solution in the lateral position, group 3 hyperbaric solution in the sitting position and group 4 hyperbaric solution in the lateral position. All patients were returned to the horizontal supine position, the sitting subjects 2 min after, and the lateral subjects immediately after, spinal injection. ⋯ There was, however, considerable scatter within each group. Posture had some effect on the speed of onset of the analgesia, but no significant effect on the final outcome. The use of 0.5% bupivacaine as a test dose in extradural blockade is discussed.
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Randomized Controlled Trial Comparative Study Clinical Trial
Extradural bupivacaine or lignocaine anaesthesia for elective caesarean section: the role of maternal posture.
Extradural anaesthesia was induced in 64 patients in either the sitting or the lateral position, for elective Caesarean section with either 0.5% plain bupivacaine or 2% lignocaine with adrenaline 1 in 200,000. Onset was significantly shorter and a significantly greater number of patients were ready for surgery within 35 min following injection of lignocaine in the lateral position. ⋯ Significantly more patients who had received the first injection of local anaesthetic agent in the sitting position required ephedrine to correct maternal hypotension. Most frequently, hypotension coincided with transfer of patients to theatre and thus was associated with movement of the patient in the presence of extensive sympathetic block.
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The amount of larynx seen at intubation was assessed in 633 adult patients undergoing routine surgery. Various measurements of the head and neck were made in an attempt to discover which features were associated with difficulty with laryngoscopy (defined as the inability to see even the arytenoids). ⋯ A simple predictive rule was developed and tested on a prospective set of 778 patients, in 1.5% of whom laryngoscopy was found to be difficult. Depending on the threshold chosen, the rule allowed the detection of, for example, 75% of the "difficult" laryngoscopies at a cost of falsely identifying 12% of the "not difficult" patients.