British journal of anaesthesia
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Twenty mothers who had requested regional analgesia during labour had a 32-gauge catheter inserted into the lumbar subarachnoid space. The mean time to place the catheters was 116 s (range 55-270 s) and there were no technical difficulties. Incremental diamorphine was given, up to a maximum initial dose of 0.5 mg. ⋯ Nine mothers were given hyperbaric 0.5% bupivacaine 1-2 ml during the second stage; all were pain free for the procedure. The maximum force needed to withdraw the catheters was 700 g; and all catheters were removed intact. There were no post-spinal headaches.
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Randomized Controlled Trial Clinical Trial
Gastric emptying during lumbar extradural analgesia in labour: effect of fentanyl supplementation.
We measured gastric emptying (by paracetamol absorption) and duration of analgesia in 30 women in labour after extradural injection of 0.375% bupivacaine 10 ml either alone or combined with fentanyl 100 micrograms. Treatment was administered double blind by random allocation after the first request for analgesia. ⋯ Mean duration of analgesia, from the first extradural bolus until return of pain in those given bupivacaine alone was 113 (87-139) min and 154 (131-176) min when fentanyl was added to the local anaesthetic (P = 0.016). These results confirm the prolongation of analgesia after fentanyl supplementation of lumbar extradural analgesia, but indicate that it results in delayed gastric emptying.
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Randomized Controlled Trial Clinical Trial
Induction dose-responses studies with propofol and thiopentone.
The relative potencies of propofol and thiopentone were assessed using different indicators of induction of anaesthesia: abolition of the response to verbal commands and eyelash stimulation. Log-probit dose-response curves for these end-points were determined 30, 60 and 90 s after induction in 96 unpremedicated ASA group I patients. ⋯ The potency ratio of propofol to thiopentone observed in this study varied from 1:1.27 to 1:2.88. It is concluded that a dose-response curve reflecting one end-point of anaesthesia cannot be used to define another end-point of anaesthesia.
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The haemodynamic responses to tracheal extubation at the end of surgery were compared with those occurring at tracheal intubation in 12 patients undergoing major elective surgery. Arterial cannulation was performed and heart rate (HR), systolic arterial pressure (SAP) and diastolic arterial pressure (DAP) were measured before induction of anaesthesia, before tracheal intubation, at the end of surgery and 1, 3 and 5 min after tracheal extubation. Laryngoscopy was avoided at the end of surgery. ⋯ Rate-pressure product (RPP) was derived from SAP x HR. After tracheal intubation there were significant (P less than 0.05) increases in HR, DAP, RPP and in plasma concentrations of both adrenaline and noradrenaline. After extubation, only HR and adrenaline concentration at 5 min after extubation increased significantly compared with measurements at the end of surgery.