British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Incidence of bradycardia during recovery from spinal anaesthesia: influence of patient position.
We administered 0.5% plain bupivacaine 4 ml intrathecally (L2-3 or L3-4) in three groups of 20 patients, according to the position in which they were nursed in the post-anaesthesia care unit (PACU): supine horizontal, 30 degrees Trendelenburg or hammock position (trunk and legs 30 degrees elevated). Patients were observed until anaesthesia descended to less than S1. The incidence of severe bradycardia (heart rate < 50 beat min-1) in the PACU was significantly higher in patients in the Trendelenburg position (60%) than in the horizontal (20%, P < 0.01) or hammock (10%, P < 0.005) position. ⋯ In four patients, severe bradycardia first occurred later than 90 min after admission to the PACU. The latest occurrence of severe bradycardia was recorded 320 min after admission to the PACU. We conclude that for recovery from spinal anaesthesia, the Trendelenburg position should not be used and the hammock position is preferred.
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Clinical Trial
Non-invasive aortic blood flow measurement in infants during repair of craniosynostosis.
We have assessed the potential clinical benefit of a new echo-Doppler device (Dynemo 3000) which provides a continuous measure of aortic blood flow (ABF) using an aortic flowmeter and a paediatric oesophageal probe, during repair of craniosynostosis in infants under general anaesthesia. The data recorded included: ABFi (i = indexed to body surface area), stroke volume (SVi), systemic vascular resistance (TSVRi), pre-ejection period (PEP), left ventricular ejection time (LVET), mean arterial pressure (MAP), heart rate (HR) and central venous pressure (CVP). Data were collected: before (T1) and 3 min after skin incision (T2), at the time of maximal haemorrhage (T3) and at the end of the procedure (T4). ⋯ ABFi, MAP and CVP were significantly lower at T3 compared with T1 (2.0 (0.8) vs 3.0 (0.8) litre min-1 m-2, 46.1 (5.8) vs 65.2 (8.9) mm Hg and 2.8 (1.6) vs 5.2 (2.1) mm Hg; P < 0.05). PEP/LVET ratio was significantly lower at T2 compared with T1 (0.25 (0.05) vs 0.30 (0.06)) and increased at T4 (0.36 (0.04); P < 0.05). These preliminary results suggest that this non-invasive ABF echo-Doppler device may be useful for continuous haemodynamic monitoring during a surgical procedure associated with haemorrhage in infants.
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Case Reports
Anaesthesia for caesarean section in the presence of severe primary pulmonary hypertension.
We describe the case of a pregnant woman, 35 weeks' gestation, with primary pulmonary hypertension and coarctation of the aorta requiring emergency Caesarean section under general anaesthesia. The patient had a pulmonary artery catheter inserted before operation which revealed pulmonary artery pressures in excess of 80/40 mm Hg. These were lowered using an infusion of glyceryl trinitrate. ⋯ An infusion of prostacyclin was substituted which stabilized pulmonary pressures. After operation, she was transferred to the intensive care unit where prostacyclin was administered by an "aerosolized" route. Her trachea was extubated after 48 h and she made an uneventful recovery.
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Biography Historical Article Classical Article
Rapid intraoperative reduction of intracranial pressure with thiopentone. 1973.