British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Influence of obesity on the spread of spinal analgesia after injection of plain 0.5% bupivacaine at the L3-4 or L4-5 interspace.
Spinal anaesthesia was compared in 40 obese patients (increased body mass index (BMI] and 40 patients with normal BMI when 3 ml of plain 0.5% bupivacaine was injected at either the L3-4 or L4-5 interspace. More extensive cephalad spread of sensory block was achieved in patients with increased BMI compared with patients with normal BMI after injection at both L3-4 and L4-5 (P less than 0.05). ⋯ Good anaesthesia was produced in all patients for orthopaedic surgery of the lower extremity. In an obese patient it is recommended that plain bupivacaine be administered at L4-5 instead of L3-4 when extensive spread of the block is to be avoided.
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A retrospective study was carried out to determine analgesic requirements in a group of orthopaedic outpatients (n = 145) and oral surgery inpatients (n = 172). The orthopaedic patients received a codeine-paracetamol premedication, an opioid during operation, or no analgesic. ⋯ In the patients undergoing oral surgery, ibuprofen administered before operation significantly reduced analgesic requirement, without unwanted side effects. The use of codeine-paracetamol or a non-steroidal anti-inflammatory agent before body surface surgery appeared to be advantageous in reducing postoperative analgesic needs, without causing problems associated with the stronger opioids.
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Randomized Controlled Trial Comparative Study Clinical Trial
Misplacement of subclavian venous catheters: importance of head position and choice of puncture site.
We have investigated the frequency of misplacement of subclavian catheters in 200 consecutive patients admitted to the Intensive Care Unit. The patients were allocated randomly to an attempt at infraclavicular cannulation of the right or left subclavian vein with the head turned either towards or away from the selected side, giving four groups. ⋯ Misplacement into the internal jugular vein occurred in 10 (5.4%) patients. No statistically significant difference (P less than 0.05) was demonstrated between the four groups.
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Randomized Controlled Trial Clinical Trial
Pretreatment with non-depolarizing neuromuscular blocking agents and suxamethonium-induced increases in resting jaw tension in children.
We have studied the effect of prior administration of non-depolarizing neuromuscular blocking drugs on suxamethonium-induced increases in masseter muscle tension in 21 children aged 3-10 yr, anaesthetized with nitrous oxide and halothane using supramaximal stimulation of the ulnar nerve and the nerve to masseter. Resting tension and isometric force of contraction were measured in the adductor pollicis and masseter muscles. A sub-paralysing dose of tubocurarine 0.05 mg kg-1, a paralysing dose of atracurium 0.5 mg kg-1 or saline was given, followed 3 min later by suxamethonium 1 mg kg-1. ⋯ It was concluded that increased muscle tone is a normal response to suxamethonium and is greater in the masseter than adductor pollicis. Sub-paralysing doses of non-depolarizing neuromuscular blockers have little effect, in contrast with paralysing doses. This suggests that the effect is mediated via postsynaptic receptors.