British journal of anaesthesia
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Pain threshold, nociceptive flexion reflex (NFR) threshold and responses to suprathreshold stimulation were investigated in 15 female patients (mean age 32 yr (range 22-48 yr)) before and 68 (range 48-96) h after gynaecological laparotomy. Control measurements were performed in 17 healthy human volunteers (five males, age 30 yr (range 24-41 yr)). In the surgical patients, pain threshold decreased and pain to suprathreshold stimulation increased significantly (P = 0.006 and P = 0.04, respectively) from before to after surgery. ⋯ The correlations between the relative change in pain and reflex thresholds, and time from surgery, were statistically significant (pain threshold: rs = 0.53, P = 0.04; NFR thresholds: rs = 0.54, P = 0.04). In the healthy volunteers, no significant differences in thresholds and responses to suprathreshold stimulation were observed between two recordings with an interval of at least 48 h. The allodynia and hyperalgesia observed in postsurgical patients may be related to postoperative sensitization of central neurones.
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We have examined interactions between midazolam, propofol and alfentanil using two end-points of light sedation (hypnosis) and anaesthesia. Quantal dose-response curves were determined in 400 female patients for the drugs individually and in combination. At the hypnotic end-point, interactions were analysed by fitting the data to a mathematical model where the response depended on the doses of the three drugs with additional terms included to describe non-additive interactions of the various combinations of the three drugs. ⋯ For anaesthesia, dose-related effects could not be demonstrated for midazolam or alfentanil when used alone. The decrease in ED50 of propofol in the presence of the other compounds was propofol-midazolam = 52%, propofol-alfentanil = 73%, propofol-midazolam-alfentanil = 82%. When comparing the different combinations, the responses varied markedly at each end-point assessed and could not be predicted from the responses of the individual agents.
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Twenty-nine departments of anaesthesia in the North of England were questioned about the availability and teaching of fibreoptic tracheal intubation techniques. While 27 departments had both suitable equipment and trained consultant staff, only one offered formal teaching to all its junior anaesthetists.
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The thrombelastograph (TEG) and bleeding time were performed before and 6 h after a single oral dose of aspirin 600 mg in a group of eight healthy volunteers and 12 pregnant patients. Measured TEG variables (r, k, r+k times and maximum amplitude) were unaltered after aspirin although there was a significant prolongation of the bleeding time in both groups. Although the TEG appeared not to detect aspirin-induced changes in platelet function, the TEG measures all phases of coagulation and the unaltered TEG after aspirin suggested a functioning coagulation system.