British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Double-blind comparison of topical lignocaine-prilocaine cream (EMLA) and lignocaine infiltration for arterial cannulation in adults.
In a double-blind, double-dummy study, the efficacy of topical 5% EMLA cream was compared with that of lignocaine infiltration in alleviating the pain of arterial cannulation. Forty unpremedicated adults were allocated randomly to four groups to receive EMLA cream alone, EMLA and 0.9% saline infiltration, EMLA and 1% lignocaine infiltration or placebo cream and 1% lignocaine infiltration. ⋯ Significantly lower pain scores were observed in all patients receiving EMLA compared with those receiving placebo cream and lignocaine infiltration by both patient (P less than 0.01) and observer (P less than 0.001) assessments. There were no significant differences between the three EMLA groups.
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Randomized Controlled Trial Clinical Trial
Spinal anaesthesia with hypobaric 0.19% or plain 0.5% bupivacaine.
Hypobaric 0.19% bupivacaine (plain 0.5% bupivacaine 3 ml + distilled water 5 ml) was compared with 0.5% plain bupivacaine 3 ml for spinal anaesthesia in 29 healthy patients undergoing orthopaedic surgery of the lower extremities. The solutions were injected at the L3-4 interspace in 40 s, and patients were kept sitting for 2 min after injection. The mean maximal cephalad spread of sensory block was to the T1 segment (SD 3.6) and to T8 (4.1) in the hypobaric and plain bupivacaine groups, respectively (P less than 0.0001). ⋯ In most patients, the hypobaric bupivacaine block affected the upper thoracic nerves, and in three patients the cervical nerves also. The high levels of block were accompanied by marked hypotension. The extensive spread of the blocks makes this hypobaric spinal anaesthesia technique unsuitable for routine use.
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Plasma concentrations of methadone were measured by gas chromatography in 16 patients receiving extradural methadone by continuous infusion for relief of postoperative pain. Venous blood samples were taken after a loading dose of extradural methadone 2 mg and during infusion of 0.46 mg h-1 plus patient-controlled increments of 0.2-1 mg. Mean (SD) plasma concentration of methadone was 9.8 (2.1) ng ml-1 at 15 min; this did not change significantly during the first 2 h, after which it increased gradually to 32.2 (4.6) ng ml-1 (P less than 0.001) at the end of 24 h. ⋯ No adverse effects were detected during the 2-3 days of methadone therapy. Plasma concentration of methadone increased significantly during patient-controlled infusion of extradural methadone in the first 24 h after operation, suggesting rapid vascular uptake. Systemic activity of the drug contributes to the analgesic effect of extradural methadone.
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Successful tracheal intubation with the flexible fibreoptic bronchoscope requires a certain amount of skill which is acquired by practice. It has been suggested that the new Bullard laryngoscope may be mastered more easily. ⋯ The Bullard laryngoscope was as easy to master as the flexible fibreoptic device, but passage of the tracheal tube took longer. Both devices require a similar amount of practice.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of two ventilators used with the T-piece in paediatric anaesthesia.
The Nuffield 200 ventilator was compared with a new valveless ventilator (CW 200) in 20 children undergoing general anaesthesia for paediatric surgery. The new ventilator incorporates design features which overcome the main disadvantages of the Nuffield 200 and make it an inherently safer machine. At identical ventilator settings it produced a significantly greater tidal volume with a reduction in end-tidal carbon dioxide partial pressure. This may have advantages in avoiding pulmonary barotrauma in children.