British journal of anaesthesia
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Comparative Study Clinical Trial Controlled Clinical Trial
Intradermal compared with prick testing in the diagnosis of anaesthetic allergy.
We have tested the hypothesis that intradermal testing is a more effective method for determining the drug responsible for anaesthetic anaphylactic reactions than prick testing in 212 consecutive patients, aged more than 10 yr, referred to an anaesthetic allergy clinic over a 4-yr period. The study was a prospective, non-randomized design. Intradermal testing was conducted using a previously described method and diluted drugs, and prick testing using undiluted drugs (with the exception of opioid analgesics which were diluted 1:10). ⋯ Intradermal testing may be easier for the infrequent user. Skin testing is valuable in the investigation of anaesthetic anaphylaxis whichever test is chosen. When there is doubt both tests should be performed.
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Randomized Controlled Trial Clinical Trial
Extradural buprenorphine suppresses breast feeding after caesarean section.
Satisfactory pain relief with postoperative extradural bupivacaine increases the amount of breast feeding after Caesarean section. To investigate the effect of extradural buprenorphine, we have evaluated the amount of breast feeding and the gain in infant weight for 11 days after Caesarean section in patients who received continuous extradural bupivacaine with or without buprenorphine. Extradural buprenorphine significantly decreased both measures although there was no significant difference in pain intensity. We suggest that extradural buprenorphine suppressed breast feeding after Caesarean section.
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Clinical Trial
Accuracy and clinical performance of a continuous intra-arterial blood-gas monitoring system during thoracoscopic surgery.
Accuracy and performance of the only currently available intra-arterial blood-gas monitoring system (Paratrend 7, PT7) were assessed in 23 patients during thoracoscopic surgery using one-lung ventilation. Over a wide range of values for arterial PO2 (6.1-61.1 kPa), PCO2 (4.1-9.5 kPa) and pH (7.19-7.50), 138 arterial blood-gas values obtained by PT7 were compared with corresponding in vitro laboratory blood-gas measurements. ⋯ Also, the bias for sequential changes between two, consecutive times was not significantly different from the ideal value of 0. We conclude that the PT7 is helpful in monitoring patients during thoracoscopy.
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Clinical Trial
Serum concentrations of bupivacaine during prolonged continuous paravertebral infusion in young infants.
We have studied the efficacy of prolonged, continuous paravertebral infusion of bupivacaine for the management of post-thoracotomy pain in 22 infants with a median age of 1.5 weeks (range 1 day to 20.4 weeks). Immediately before chest closure, 0.25% bupivacaine 1.25 mg kg-1 was given into an extrapleural paravertebral catheter, inserted under direct vision. Subsequently, 0.125% bupivacaine with adrenaline 1:400000 was infused at a rate of 0.2 ml kg-1 h-1 for 48 h. ⋯ The technique provided effective post-operative pain relief in 86% of patients, with three patients requiring morphine in addition. Mean serum concentration of bupivacaine after 48 h was 1.60 (0.67) micrograms ml-1, but bupivacaine concentrations > 3 micrograms ml-1 were found in three patients at 30-48 h. There were no major complications relating to the technique, and paravertebral block was an effective method of providing prolonged post-thoracotomy analgesia in these young infants.