British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of incremental spinal anesthesia using a 32-gauge catheter with extradural anaesthesia for elective caesarean section.
Forty-three mothers who had requested regional anaesthesia for elective Caesarean section were allocated randomly to receive either extradural anaesthesia with pH-adjusted 2% lignocaine with 1/200,000 adrenaline, or incremental spinal anaesthesia using a 32-gauge catheter with 0.5% plain bupivacaine. Increments of lignocaine or bupivacaine were given with the aim of achieving a block from T4 to S5. The spinal catheter was quicker to place (median 3 min, range 1-45 min, compared with median 10 min, range 1.5-50 min) and spinal anaesthesia was quicker to establish (median 20 min, range 10-46 min compared with median 48 min, range 15-59 min) compared with the extradural technique. ⋯ Haemodynamic stability and the quality of the block were similar between the groups. There were two mild spinal-headaches in the spinal group. All the spinal catheters were removed intact.
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A case is described of spontaneous tension pneumothorax occurring during preparation for thoracic surgery. The earliest indication of this was unexplained haemoglobin desaturation as detected by pulse oximetry. This case report provides another example of the early warning potential of pulse oximetry.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparative study of the effects of air or saline to identify the extradural space.
Fifty women in labour were allocated randomly to receive either air or saline to assist in the identification of the extradural space by the loss of resistance technique. A study volume of 4 ml of air or saline was used before 0.5% bupivacaine 8 ml and the spread of analgesia was followed for 30 min. ⋯ All unblocked segments were blocked subsequently by further doses of bupivacaine. We conclude that air is more likely than saline to produce unblocked segments in the initiation of extradural analgesia in labour.
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Randomized Controlled Trial Comparative Study Clinical Trial
Extradural diamorphine with adrenaline in labour: comparison with diamorphine and bupivacaine.
In a randomized double-blind study of 51 primigravida, we have examined the relative efficacies of bupivacaine, diamorphine or diamorphine with adrenaline given by the extradural route for relief of pain during labour. Group 1 (n = 18) received diamorphine 5 mg in 0.9% sodium chloride 8 ml; group 2 (n = 19) received diamorphine 5 mg in 0.9% sodium chloride 8 ml with 1:200,000 adrenaline; group 3 (n = 14) received 0.375% bupivacaine 8 ml. All patients received 0.375% bupivacaine 8 ml as a supplement after the initial analgesia had subsided. ⋯ There were no serious adverse effects in any group, but pruritus was a feature in the diamorphine groups. Diamorphine 5 mg may be used as an alternative to bupivacaine 0.375% 8 ml in the first stage of labour and provides a longer duration of action. The addition of adrenaline 1:200,000 appears to augment both the quality and duration of analgesia.
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Randomized Controlled Trial Comparative Study Clinical Trial Controlled Clinical Trial
Priming of pancuronium with magnesium.
Magnesium inhibits the release of acetylcholine from the motor nerve terminal and thus potentiates the action of the non-depolarizing neuromuscular blocking drugs. We have examined the possibility that this effect might enhance the speed of onset of non-depolarizing block with pancuronium. ⋯ Tracheal intubation was performed after 97.8 (22.5) s in the magnesium group and in 121.0 (37.5) s in the control group (ns). It is concluded that pretreatment with magnesium does not usefully increase the speed of onset of action of pancuronium.