British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Diclofenac and ketoprofen for pain treatment after elective caesarean section.
We have studied the effect of a constant infusion of diclofenac 150 mg/24 h, ketoprofen 200 mg/24 h or placebo on postoperative pain after elective Caesarean section performed under spinal or extradural block in 90 patients in a prospective, randomized and double-blind study. During the first 24 h after operation, patients in the treatment groups were more comfortable than the placebo group (P < 0.005); the diclofenac group needed a mean of oxycodone 21.6 mg/24 h and the ketoprofen group 21.2 mg/24 h, compared with 38.3 mg/24 in the placebo group (P < 0.001); the mean time to the first injection of oxycodone was 270.5 min in the diclofenac group, 270.2 min in the ketoprofen group and 161.2 min in the placebo group (P < 0.001). ⋯ One patient in the diclofenac group was eliminated from the study because of uterine relaxation during the first 30 min after start of the drug infusion; this improved after cessation of diclofenac and infusion of sulprostone. There were no other serious side effects.
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Three cases of extradural abscess with delayed presentation after extradural analgesia have been reported previously. The present report describes a patient with alcohol abuse who was treated for 5 days with extradural injections of bupivacaine for pain from multiple rib fractures. The first symptoms of an extradural abscess developed approximately 11 days after removal of the extradural catheter, and definite diagnosis was delayed a further 7 days.
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Comparative Study
Comparison of portable emergency ventilators using a lung model.
A lung model was used to test the performance of five emergency ventilators (MEDUMAT Elektronik, MEDUMAT Variabel, OSIRIS, OXYLOG and rescuPAC 2DM). The model comprised two glass jars filled with water to suitable compliances and connecting tubes. ⋯ Preset minute volume was compared with measured minute volume and the gas distribution produced by the different ventilators. Acceptable performance was found with the MEDUMAT Elektronik, MEDUMAT Variabel, OSIRIS and OXYLOG ventilators.
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We have studied the effects of extrinsically applied PEEP (PEEPe) and intrinsic PEEP (PEEPi) on lung volume and peak airway pressure (Paw,peak) in 10 patients with airflow limitation during mechanical ventilation. PEEPe was applied in 2-4 cm H2O increments until values greater than PEEPi were reached. Total lung hyperinflation was quantified by measuring the expired volume resulting from deflation (starting at end inspiration) until cessation of expiratory flow. ⋯ PEEPe at pressures less than PEEPi increased delta FRC by (mean) 186 (SEM) 34 ml/kPa PEEPe (P < 0.05) and increased Paw,peak by 0.6 (0.12) kPa/kPa PEEPe (P < 0.05). In contrast, PEEPe at pressures greater than PEEPi, increased delta FRC by 695 (128) ml/kPa PEEPe (P < 0.05) and Paw,peak by 1.8 (0.26) kPa/kPa PEEPe. We conclude that PEEPe may be applied cautiously at values less than PEEPi when clinically indicated, but the application of PEEPe at values greater than PEEPi may substantially aggravate lung hyperinflation.
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Analysis of small oscillations in heart rate (known as heart rate variability or HRV) associated with the activity of homeostatic reflexes can provide a noninvasive measure of autonomic reflex function. We have investigated the effects of surgical stimulation on autonomic reflex function by assessment of changes in HRV. Healthy female patients undergoing laparoscopic tubal ligation were anaesthetized with either thiopentone-nitrous oxide-isoflurane (group I; n = 13) or continuous propofol infusion (group P; n = 13). ⋯ Compared with control values, measurements of HRVtot before incision were reduced significantly in both groups (group P: 16 (SEM 3)% of control; group I: 2.5 (0.7)% of control). With surgical stimulation, mean HRVtot in group P was restored to 55 (13)% of control (P < 0.01 compared with measurement before incision), whereas mean HRVtot in group I remained at less than 4% of control (ns). %HRVlo increased also in group P, from 49 (7)% to 75(3)% (P < 0.05), consistent with a shift in sympathetic-parasympathetic balance towards sympathetic dominance. These results suggest that surgical stimulation may have significant effects on the autonomic reflexes mediating HRV, and that such effects vary with anesthetic technique.