British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Acupressure and prevention of nausea and vomiting during and after spinal anaesthesia for caesarean section.
The efficacy of acupressure at the P6 point in the prevention of nausea and vomiting during and after Caesarean section was studied. A double-blind, randomized controlled study of acupressure vs placebo was designed. ⋯ The use of acupressure reduced the incidence of nausea or vomiting from 53% to 23% compared with placebo (95% confidence interval (CI) 0.34-0.25; P = 0.002) during the operation and from 66% to 36% compared with placebo (95% CI 0.34-0.19; P = 0.003) after the operation. Other variables were similar between the groups.
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A 23-yr-old primagravida sustained a dural puncture during epidural catheter insertion and developed a headache that settled with oral diclofenac and codydramol. On the third day after delivery, she convulsed twice without warning. As plasma urate was increased, the putative diagnosis of an eclamptic fit was made, and magnesium therapy was started. ⋯ A coincidental arteriovenous malformation was noted. This case emphasises the need to consider the differential diagnoses of post-partum headache. The management of acute intracranial haematoma is described.
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Comparative Study
Pharmacokinetics of inhaled anaesthetics in a clinical setting: comparison of desflurane, isoflurane and sevoflurane.
The pharmacokinetic characteristics of desflurane, isoflurane and sevoflurane (16 patients for each anaesthetic) were estimated from measurements of inspired and end-expired agent concentrations and ventilation, obtained during routine anaesthesia in patients undergoing maxillofacial surgery (mean age 38 yr, duration of anaesthesia approximately 2 h). A two-compartment model described the data adequately. Although isoflurane and sevoflurane have almost the same tissue/blood partition coefficients, significant differences between substances were observed for the peripheral volume of distribution (medians and ranges: desflurane, 612 (343-1850) mlvapour kgbw-1; isoflurane, 4112 (1472-9396) mlvapour kgbw-1; sevoflurane, 1634 (762-8843) mlvapour kgbw-1) and the transport clearance from the central to the peripheral compartment (desflurane, 7.0 (4.4-11.1) mlvapour kgbw-1 min-1; isoflurane, 30.7 (15.9-38.7) mlvapour kgbw-1 min-1; sevoflurane, 13.0 (9.8-22.4) mlvapour kgbw-1 min-1). Thus, during clinical anaesthesia the important characteristics of the compounds could be obtained and compared between substances from simple data.
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Pharmacokinetic parameters of inhaled anaesthetics have previously been assessed experimentally in healthy volunteers. In contrast, we developed a method to estimate pharmacokinetic parameters under clinical conditions. We obtained data from the continuous routine monitoring of fractional concentration and ventilation during anaesthesia with desflurane, isoflurane and sevoflurane. ⋯ The most stable parameter was the intercompartmental clearance, and the most sensitive parameter was the volume of distribution. The bias in pharmacokinetic parameters caused by adding errors to measured concentrations was similar for the different compounds. We conclude that the model allows the estimation of an alternative set of pharmacokinetic parameters that can reliably describe the behaviour of volatile anaesthetics under clinical conditions, and allow comparison between agents.
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Meta Analysis
General versus regional anaesthesia for hip fracture surgery: a meta-analysis of randomized trials.
Hip fracture surgery is common and the population at risk is generally elderly. There is no consensus of opinion regarding the safest form of anaesthesia for these patients. We performed a meta-analysis of 15 randomized trials that compare morbidity and mortality associated with general or regional anaesthesia for hip fracture patients. ⋯ No other outcome measures reached a statistically significant difference. There was a tendency towards a lower incidence of myocardial infarction, confusion and postoperative hypoxia in the regional anaesthetic group, and cerebrovascular accident and intra-operative hypotension in the general anaesthetic group. We conclude that there are marginal advantages for regional anaesthesia compared to general anaesthesia for hip fracture patients in terms of early mortality and risk of deep vein thrombosis.