British journal of anaesthesia
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Meta Analysis
Meta-analysis of the efficacy of extradural clonidine to relieve postoperative pain: an impossible task.
Clonidine, an alpha2 adrenoceptor agonist, has anti-hypertensive and anti-nociceptive effects. It is commonly used in association with local anaesthetics and opioids to enhance the quality and duration of extradural analgesia in the postoperative period, and to decrease the incidence of side effects. As a sole analgesic, it has seldom been used to relieve postoperative pain. ⋯ The data from these studies were difficult to interpret because of the tremendous variation in variables, especially dose of clonidine, level of extradural injection, time of administration, type of anaesthesia, type of surgery, and reference and rescue drugs. The simultaneous extradural use of local anaesthetics and opioids further hindered data interpretation, and precluded any meta-analysis. Proposals for a standard study design are made to help comparison between studies involving extradural clonidine and postoperative pain.
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Randomized Controlled Trial Comparative Study Clinical Trial
Intrathecal diamorphine compared with morphine for postoperative analgesia after caesarean section under spinal anaesthesia.
A randomized, double-blind study of 40 women was performed to compare patient controlled anaesthesia (PCA) morphine requirements after spinal anaesthesia for elective Caesarean section. The women received 0.2 mg of either morphine or diamorphine mixed with 0.5% bupivacaine in 8% dextrose. ⋯ Similarly, the VAS for drowsiness were significantly higher in the morphine group at 6 and 8 h. Overall there was no difference in the 24-h PCA morphine demands between the two groups (diamorphine patients 5.5 mg, morphine patients 5.0 mg.
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The influence of aging on the pharmacodynamics of anaesthetic agents in the central nervous system remains poorly understood. As alpha-aminobutyric acid (GABA)-mediated neurotransmission appears to be an important target for anaesthetics in the brain, we hypothesized that aging could alter the sensitivity of the GABA carrier to anaesthetics. We have examined the effects of etomidate and propofol on the uptake of [3H]-GABA (5 min, 37 degrees C) into striatal synaptosomes of rats aged 2, 18 and 24 months. ⋯ Aging increased IC50 values for these anaesthetics. Nipecotic acid was unaffected. These data suggest that aging selectively alters the action of etomidate and propofol in the mammalian CNS.
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One hundred and six former or current flexible trainees in anaesthesia responded to a questionnaire evaluating their part-time training (a response rate of 71%). They were compared with a group of 32 flexible trainees in obstetrics and gynaecology. ⋯ Nearly all those who had finished their training were working as consultants (54% of the whole group); 4% had either retired, become a clinical assistant or a locum consultant. The remainder (42%) were senior registrars.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Comparison of ropivacaine with bupivacaine for paediatric caudal block.
In a double-blind, multicentre study 245 children aged 1-10 yr undergoing elective minor surgery as inpatients were randomly allocated to receive a single caudal extradural injection of 1 ml kg-1 of either 0.25% bupivacaine or 0.2% ropivacaine after induction of light general anaesthesia. The groups were comparable for age, weight, vital signs and duration of surgery. The onset time was similar for ropivacaine and bupivacaine (9.7 vs 10.4 min). ⋯ The mean time to first analgesia in the remainder was 233 min in the bupivacaine group and 271 min in the ropivacaine group. No motor block was measurable in either group. Ropivacaine 2 mg kg-1 was as effective as bupivacaine 2.5 mg kg-1 for caudal analgesia in children.