British journal of anaesthesia
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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.
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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.
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Randomized Controlled Trial Clinical Trial
Prophylactic ephedrine during spinal anaesthesia: double-blind study in patients in ASA groups I-III.
Forty-eight patients scheduled to undergo spinal anaesthesia were allocated to three groups of 16 each according to ASA classification I-II-III. Each patient received a fluid load of 7 ml kg-1 and either ephedrine 12.5 mg i.v. and 37.5 mg i.m., or placebo. ⋯ In ASA risk group III, all patients in the placebo group had a decrease in mean arterial pressure exceeding 20%; in 50% of these patients, the decrease exceeded 33%. We conclude that prophylactic ephedrine is desirable for spinal anaesthesia, especially in ASA III patients.
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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.
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Randomized Controlled Trial Clinical Trial
Effect of peroperative normothermia on postoperative protein metabolism in elderly patients undergoing hip arthroplasty.
We have examined in elderly patients the effect of maintenance of normothermia during hip surgery on postoperative protein metabolism. In one group of six patients (warmed group) heat loss was minimized during surgery and in the recovery period by warming fresh gases, i.v. fluids and wrapping the exposed parts of the body with a warming blanket. In a second group of six patients (cold group), routine care was provided. ⋯ Total body potassium (TBK), measured as an index of body cell mass, decreased significantly after surgery in both groups. However, 7 days after surgery the reduction in TBK in the cold group remained significantly lower than that of the warmed group (P less than 0.05). Maintenance of normothermia during hip surgery appeared to attenuate, but not eliminate, protein breakdown and nitrogen loss after surgery.