British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Learning fibreoptic intubation: use of simulators v. traditional teaching.
This study compared a graduated training programme with that of a traditional teaching method to facilitate the learning of the technique of fibreoptic nasotracheal intubation. Thirty-two anaesthesia trainees were randomly assigned to two groups. ⋯ Nasotracheal intubation was accomplished significantly more often by the trainees in the graduated programme (86 out of 96 (89.6%) v. 64 out of 96 (66.5%) (P less than 0.01). The results demonstrate that trainees who undergo a graduated training programme using simulators are initially more successful at awake fibreoptic nasotracheal intubation than those who have learned in the traditional manner, and that the conditions of the investigation were acceptable to the trainees and patients.
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Randomized Controlled Trial Comparative Study Clinical Trial
Intercostal nerve blockade producing analgesia after appendicectomy.
Intercostal nerve blockade of the 10th, 11th and 12th thoracic nerves on the right side was compared with i.m. papaveretum as analgesia after appendicectomy. Patients with intercostal nerve blockade had significantly less pain at 0, 4, 8 and 12 h after operation and required less papaveretum (mean 0.26 mg kg-1/24 h) compared with the controls (mean 0.62 mg kg-1/24 h). There were no complications in either group. Intercostal nerve blockade may provide better quality analgesia following appendicectomy than i.m. papaveretum alone.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of large dose of vecuronium with pancuronium for prolonged neuromuscular blockade.
Dose-duration relationships for vecuronium were determined and the duration of action produced by vecuronium 0.3 mg kg-1 shown to equal that of pancuronium 0.1 mg kg-1. Using these doses, the neuromuscular blocking properties and cardiovascular effects of the two drugs were compared. With large dose administration of vecuronium (0.3 mg kg-1), both the onset time (mean 81 s) and the 25-75% recovery index (mean 13.9 min) were about one-half those associated with pancuronium (mean 168.5 s and 29.3 min, respectively). ⋯ There was no evidence of cardiovascular instability with the large dose of vecuronium. Heart rate, however, was significantly slower (range 89.7-94.2% of control) 2-20 min after the injection of vecuronium. Vecuronium 0.3 mg kg-1 may have more favourable neuromuscular blocking effects than pancuronium 0.1 mg kg-1 and may be preferable to pancuronium when prolonged neuromuscular blockade is required.
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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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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.