British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of different bolus doses of morphine for patient-controlled analgesia in children.
Forty children undergoing appendicectomy were allocated randomly to receive one of two PCA regimens with morphine. Group B10 received bolus doses of 10 micrograms kg-1 and group B20 received bolus doses of 20 micrograms kg-1. In both groups there was a lockout interval of 5 min and a background infusion of 4 micrograms kg-1 h-1. ⋯ There was no difference between the pain scores of the groups at rest. Group B20 had significantly (P < 0.05) smaller pain scores during movement than group B10 and the latter group suffered significantly (P < 0.01) more hypoxaemic episodes than group B20. There were no differences between the groups in the incidence of vomiting, excess sedation or the amount of time spent asleep at night.
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Randomized Controlled Trial Comparative Study Clinical Trial
Hypotension during subarachnoid anaesthesia: haemodynamic analysis of three treatments.
We have compared three methods of preventing hypotension during subarachnoid anaesthesia. We attempted to maintain systolic arterial pressure (SAP) greater than 75% of baseline by use of i.v. fluids (preloading with normal saline 16 ml kg-1 and, if necessary, three subsequent boluses of 2.5 ml kg-1), an infusion of metaraminol titrated as necessary between 0 and 5 mg h-1 and an infusion of ephedrine titrated as necessary between 0 and 120 mg h-1. SAP and mean arterial pressure (MAP) were measured by automated oscillotonometry, central venous pressure (CVP) by a manometer and cardiac index (CI), stroke index (SI) and heart rate (HR) by transthoracic electrical bioimpedance. ⋯ The main cardiovascular change was decreased HR (15 (8)%; P = 0.0001). Ephedrine failed to maintain SAP in two of 12 patients and was accompanied by several cardiovascular changes: HR (21 (12)%; P = 0.001) increased and SI (16 (10)%; P = 0.0001), CVP (3.8 (1.5) cm H2O; P = 0.0001) and SVRI (24 (6)%; P = 0.0001) decreased. Treatment failures resulted from failures to maintain SVRI in the fluid group and CVP and SVRI in the ephedrine group.
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Randomized Controlled Trial Clinical Trial
Hypertonic saline prehydration in patients undergoing transurethral resection of the prostate under spinal anaesthesia.
Thirty-three patients undergoing elective transurethral resection of the prostate were allocated randomly to receive either 0.9% isotonic saline 7 ml kg-1 (16 patients), or 3% hypertonic saline 7 ml kg-1 (17 patients) as a preload before spinal anaesthesia. After spinal anaesthesia, the incidence of systolic arterial pressure < 75% of control value was greater in the normal saline group than in the hypertonic saline group. Also, the mean dose of phenylephrine required to maintain arterial pressure > 75% of the baseline value was significantly greater in the normal saline group than in the hypertonic saline group.
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The American College of Surgeons' Advanced Trauma Life Support procedure teaches that blind nasotracheal intubation should be performed in the presence of a suspected or proven cervical spine injury in an unconscious but breathing patient who requires an artificial airway. We studied a group of non-anaesthetically trained graduates of the Advanced Trauma Life Support course and examined their skill in performing blind nasal intubations. ⋯ We conclude that, in British hospitals, blind nasotracheal intubation should not be recommended as the first line management in securing the airway of patients with suspected or proven cervical spine injury. Alternative techniques such as bag-and-mask ventilation with cricoid pressure or a laryngeal mask airway with cricoid pressure should be adopted until oral intubation with in-line traction is performed.