British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Visceral pain during caesarean section: effect of varying dose of spinal amethocaine.
The aim of this study was to determine how varying the dose of spinal amethocaine influences the incidence of visceral pain associated with exteriorization of the uterus after delivery. In a double-blind study, we examined the incidence of visceral pain in 40 parturients undergoing Caesarean section under spinal anaesthesia with amethocaine 8, 10, 12 or 14 mg in 2 ml of 5% glucose. ⋯ The incidence of visceral pain was lower in the 12-mg (P < 0.05) and 14-mg (P < 0.01) groups than in the 8-mg group, although there were no differences in maximum spread of analgesia and circulatory changes between the four groups. This study suggests that a slightly higher dose of spinal amethocaine (12-14 mg) is preferable for Caesarean section.
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A wartime embargo on casualty figures and an imprecise contemporary editorial contributed to the persisting belief that a grossly excessive mortality rate from barbiturate anaesthesia for surgery of the injured occurred after the Japanese attack on the American bases in Hawaii in December 1941. From accounts by surgical staff and official hospital records which have become available through US Freedom of Information legislation, it is clear that the rumoured death rate from this cause has been greatly exaggerated.
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Anaesthesia-induced malignant hyperthermia (MH) may be caused by specific gene defects in the skeletal muscle ryanodine receptor. We have studied the frequency of occurrence of the C1840T mutation, analogous to the porcine mutation, and three mutations associated both with MH and central core disease (G7301A, C487T and C1209G). We investigated skeletal muscle specimens from up to 137 patients testing negative and 101 patients testing positive for MH susceptibility by the North American MH Group protocol. ⋯ One subject with central core disease did not have any of the three mutations examined associated with this disorder. Therefore, the porcine and central core disease-associated mutations examined in the ryanodine receptor account for a small proportion (approximately 3%) of MH-positive diagnoses. The mutations examined did not occur in any of the MH-negative patients, supporting an association between defects in the ryanodine receptor and a positive diagnosis for MH.(ABSTRACT TRUNCATED AT 250 WORDS)
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The combined spinal-extradural technique is used to provide analgesia and anaesthesia in obstetric anaesthetic practice. The accidental insertion of an extradural catheter into the dural opening made previously by the spinal needle is thought to be a theoretical risk. We report a case during combined spinal-extradural anaesthesia for Caesarean section in which this complication occurred.
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Editorial Comment
Volume preloading, spinal hypotension and caesarean section.