British journal of anaesthesia
-
Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of bupivacaine and bupivacaine with fentanyl in continuous extradural analgesia during labour.
In a randomized, double-blind study of 39 mothers in labour, we have compared a loading dose of 0.5% bupivacaine 6.0 ml and fentanyl 100 micrograms given extradurally, followed by an infusion of 0.08% bupivacaine 15 ml h-1 plus fentanyl 37.5 micrograms h-1, with a loading dose of 0.5% bupivacaine 6.0 ml and saline 2.0 ml, followed by an extradural infusion of 0.08% bupivacaine alone, per hour. Analgesic levels were more consistent and sustained in mothers who received fentanyl in addition to bupivacaine, and the duration from the time of the loading dose to the first top-up was extended considerably in this group. The only significant side effect was a high incidence of mild pruritus in the fentanyl group. The addition of fentanyl to the extradural loading dose and subsequent infusion of local anaesthetic is a satisfactory alternative to giving higher doses of local anaesthetic alone.
-
The multiple occlusion technique was used to study the effects of paralysis on ventilatory mechanics during anaesthesia. Total respiratory compliance (Crs) was measured during spontaneous breathing and following neuromuscular block with controlled ventilation in 23 infants. ⋯ A possible cause of these differences may be the type of controlled ventilation given during paralysis, with tidal volume directly influencing values of Crs obtained. The results of this study suggest that values of Crs obtained during spontaneous breathing and paralysis should not be used interchangeably until further studies have been performed to assess factors influencing Crs during controlled ventilation.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Analgesia-induced respiratory depression: comparison of meptazinol and morphine in the postoperative period.
Forty-nine patients undergoing elective total hip replacement received either morphine or meptazinol for postoperative analgesia from a patient-controlled analgesia apparatus. Ventilatory rate and volume and arterial oxyhaemoglobin saturation were recorded continuously for the first 24 h following surgery. Episodic hypoxaemia was seen in both groups, associated with disturbances in ventilatory pattern. ⋯ The mean number of demands for analgesic drugs was similar in the two groups. The meptazinol group had a greater requirement for anti-emetic drugs than the morphine group (P less than 0.05). It was concluded that meptazinol and morphine in equianalgesic doses had similar effects on ventilation in the postoperative period.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Pressor and catecholamine response to nasal intubation of the trachea.
The catecholamine and cardiovascular responses to nasal intubation of the trachea with and without laryngoscopy have been compared in 23 patients allocated randomly to each treatment. Arterial pressure, heart rate and plasma concentrations of adrenaline and noradrenaline were measured before and after induction and at 1, 3 and 5 min after intubation of the trachea. There were significant increases in systolic and diastolic pressures after tracheal intubation in both groups. The values at 1 min after intubation were significantly higher in the group undergoing laryngoscopy and intubation compared with the group undergoing blind nasal intubation.