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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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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Comparative Study
Epidural top-up solutions for emergency caesarean section: a comparison of preparation times.
We compared the preparation times of three solutions commonly used for epidural top-up for emergency Caesarean section. Twenty-two anaesthetists were asked to prepare fresh solutions in random order as quickly as possible: 0.5% bupivacaine 20 ml (B); 2% lidocaine 20 ml with 1:200,000 epinephrine (LE); and 0.5% bupivacaine 10 ml and 2% lidocaine 10 ml with 1:200,000 epinephrine and 8.4% sodium bicarbonate 2 ml (BLEB). Preparation times for B were approximately half of those for LE, which in turn were approximately half of those for BLEB (P = 0.0001). If local anaesthetic solutions with additives such as epinephrine or bicarbonate are prepared just before emergency Caesarean section, any possible reduction in onset time that they might afford may be offset by the additional preparation time required.
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Nineteen previously trained resident anaesthetists were instructed to perform adult single-rescuer basic life support for 5 min on a manikin, in a double-blind crossover design, changing the hand of contact with the sternum from right to left while performing external cardiac compression (ECC). Total, correct and incorrect ECCs comprising of inadequate depth, wrong hand placement, incomplete relaxation and too much compression were recorded and grouped according to the dominant hand (group DH) or non-dominant hand (group NH) in contact with the sternum. The number of correct ECCs was significantly greater in group DH, median 141 compared to group NH, median 97; P < 0.005. ⋯ Similarly, the incidence of wrong hand placement was significantly higher in group NH; median of 4 versus median of 0 in group DH, P < 0.05. The incidence of incomplete relaxation and too much ECC was not significantly different between the two groups (P < 0.05). We conclude that ECC is performed with fewer errors when the dominant hand of the rescuer is placed in contact with the sternum.