British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of 1% ropivacaine with 0.75% bupivacaine and 2% lidocaine for peribulbar anaesthesia.
We have compared the efficacy of 1% ropivacaine with a mixture of 0.75% bupivacaine and 2% lidocaine for peribulbar anaesthesia in cataract surgery. We used the time to adequate block for surgery, and ocular and eyelid movement scores at 8 min after block as clinical end-points. Ninety patients were allocated randomly to receive 7-10 ml of a mixture of equal parts of 0.75% bupivacaine and 2% lidocaine or an equal volume of 1% ropivacaine alone. ⋯ Median eyelid movement scores were similar in both groups, but the bupivacaine and lidocaine mixture produced a significantly decreased ocular movement score at 2, 4 and 6 min (P < 0.05). There was no difference between groups in the incidence of minor complications. Based on clinical end-points, time to adequate block for surgery and median ocular and eyelid movement scores at 8 min, 1% ropivacaine as the sole agent for peribulbar anaesthesia was comparable with a mixture of 0.75% bupivacaine and 2% lidocaine.
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Randomized Controlled Trial Clinical Trial
A placebo-controlled study of the effects of dopexamine on gastric mucosal perfusion in infants undergoing hypothermic cardiopulmonary bypass.
We used a laser Doppler probe to measure gastric mucosal blood flow (flux) and a paediatric tonometer to intermittently calculate gastric-arterial PCO2 difference (PrCO2-PaCO2 gap) in 50 infants aged 0.3-52 weeks who required hypothermic cardiopulmonary bypass (CPB). During CPB, patients in group 2 (n = 25) were given dopexamine 1.0 mg kg-1 over 5 min, followed by an infusion of 2 micrograms kg-1 min-1. Patients in group 1 (n = 25) received an equal volume of saline. ⋯ Similarly, mean PrCO2-PaCO2 gap increased significantly from 3.6 (6.3) to 8.2 (6.7) in group 1 (P = 0.01) compared with a significant decrease from 5.8 (5.5) to 2.1 (5.5) in group 2 (P = 0.02). Mean PrCO2-PaCO2 gap after rewarming in group 2 was significantly higher than that in group 1 (P = 0.001). These data indicate that dopexamine may be useful in maintaining normal gut perfusion in infants requiring hypothermic CPB.
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We have studied the effects of increases in isoflurane concentration on the EEG bispectral index (BIS) in 70 patients anaesthetized with isoflurane-nitrous oxide-sufentanil for major abdominal surgery. During surgery, baseline BIS was recorded at 0.8% end-tidal isoflurane with nitrous oxide in oxygen (FIO2 0.35). After this, end-tidal isoflurane was increased to 1.6% for 15 min and decreased subsequently to 0.8% for 20 min to assess recovery. ⋯ Patients with a decrease in BIS were significantly younger (38 (range 18-68) yr) than those with unchanged (55 (26-70) yr) or increased (60 (40-70) yr) BIS values (P < 0.001). It is possible that the paradoxical increase in BIS is related to continuous pre-burst EEG patterns consisting of high-frequency activity. This suggests that the use of BIS as a guide for isoflurane administration may be misleading in some patients undergoing surgical procedures.
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Quality of recovery after anaesthesia is an important measure of the early postoperative health status of patients. We attempted to develop a valid, reliable and responsive measure of quality of recovery after anaesthesia and surgery. We studied 160 patients and asked them to rate postoperative recovery using three methods: a 100-mm visual analogue scale (VAS), a nine-item questionnaire and a 50-item questionnaire; the questionnaires were repeated later on the same day. ⋯ The QoR-40 was completed in less than 6.3 (4.9) min. We believe that the QoR-40 is a good objective measure of quality of recovery after anaesthesia and surgery. It would be a useful end-point in perioperative clinical studies.
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A patient experienced a severe vasovagal attack during regional anaesthesia for elective Caesarean section. The combination of vagal over-activity and sympathetic block produced profound hypotension that threatened the life of the mother and infant. The vasovagal syndrome is described, and its prevention and management discussed.