British journal of anaesthesia
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Comment Letter Case Reports
Sevoflurane for difficult intubation in children.
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Randomized Controlled Trial Comparative Study Clinical Trial Controlled Clinical Trial
Neuromuscular monitoring by intensive care nurses: comparison of acceleromyography and tactile assessment.
We have compared tactile assessment of the train-of-four (TOF) count and TOF ratio by nursing staff, with measurements made by a new acceleromyographic monitor, the TOF-Watch. We assessed neuromuscular block in 30 sedated intensive care patients receiving a continuous infusion of atracurium. ⋯ Each assessment was paired with a blinded TOF-Watch measurement. The nurses were accurate in assessing twitch count in 55% of measurements and they tended to overestimate the degree of block using tactile assessment of TOF ratio.
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Randomized Controlled Trial Comparative Study Clinical Trial
Extradural S(-)-bupivacaine: comparison with racemic RS-bupivacaine.
Bupivacaine has a chiral centre and is currently available as a racemic mixture of its two enantiomers: R(+)-bupivacaine and S(-)-bupivacaine. Preclinical studies have demonstrated that there is enantiomer selectivity of action with the bulk of central nervous system and cardiovascular toxicity residing with the R(+) isomer. The aim of this study was to compare the clinical efficacy and safety of S(-)-bupivacaine with racemic RS-bupivacaine for extradural anaesthesia. ⋯ There was no difference in onset time, maximum spread of sensory block or intensity of motor block between the three groups. Duration of sensory block was significantly longer for 0.75% S(-)-bupivacaine. We conclude that S(-)-bupivacaine has similar local anaesthetic characteristics to RS-bupivacaine when used for extradural anaesthesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Double-blind comparison of extradural block with three bupivacaine-ketamine mixtures in knee arthroplasty.
We have compared 0.5% bupivacaine 75 mg (group A; n = 15) with three 0.5% bupivacaine 75 mg-ketamine mixtures for extradural block in 59 ASA I-III patients undergoing total knee replacement in a randomized, double-blind study. The following doses of preservative-free 1% ketamine were used: 0.3 mg kg-1 (group B: n = 14); 0.5 mg kg-1 (group C: n = 5); and 0.67 mg kg-1 (group D: n = 15). Level of sensory block, degree of motor weakness and sedation scores were recorded before and after operation. ⋯ There was no significant difference between groups in median duration of analgesia (group A: 240 (range 115-340) min; group B: 198 (97-460) min; group C: 150 (122-448) min; and group D: 210 (130-390) min). No patient suffered any adverse psychomimetic effects. We conclude that at the doses used, addition of ketamine to extradural bupivacaine did not improve extradural block in adult patients undergoing total knee replacement.
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Randomized Controlled Trial Clinical Trial
Addition of clonidine or fentanyl to local anaesthetics prolongs the duration of surgical analgesia after single shot caudal block in children.
Caudal anaesthesia is indicated for surgical procedures lasting less than 90 min. Fentanyl and clonidine are known to prolong postoperative caudal analgesia, but there are no data on their effect on duration of surgical analgesia. We evaluated if the addition of clonidine or fentanyl to local anaesthetics prolonged the duration of surgical analgesia after single shot caudal block in children in a randomized, double-blind study. ⋯ Vomiting was observed only in children who received fentanyl. Addition of clonidine or fentanyl to local anaesthetics prolonged the duration of surgical analgesia of caudal block, allowing single shot caudal anaesthesia to be recommended for surgery lasting 90-150 minutes. Clonidine had some advantages over fentanyl as it did not produce clinically significant side effects.