British journal of anaesthesia
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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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Case Reports Randomized Controlled Trial Clinical Trial
Comparison of the effectiveness of bilateral ilioinguinal nerve block and wound infiltration for postoperative analgesia after caesarean section.
We have studied the effects of bilateral ilioinguinal nerve block and wound infiltration with 0.5% bupivacaine on postoperative pain and analgesic requirements in 62 patients undergoing Caesarean section under general anaesthesia. A control group received no local anaesthetic supplementation. Both ilioinguinal block and wound infiltration reduced significantly the pain scores and analgesic requirements in the immediate postoperative period (P < 0.05). The differences in pain scores and analgesic requirements between the study groups were not statistically significant (P > 0.05).