British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Randomized controlled study of colloid preload before spinal anaesthesia for caesarean section.
We randomized women having elective Caesarean section to receive either no preload (control group, n=33) or 4% gelatin solution (Gelofusine) 15 ml kg(-1) (colloid group, n=35) i.v. before spinal anaesthesia. Intravenous metaraminol was titrated at 0.25-0.75 mg min(-1) to maintain systolic arterial pressure (SAP) in the target range 90-100% of baseline after the spinal injection. ⋯ Nausea was less frequent in the colloid group (6 vs 24%) but neonatal outcome was similar in the two groups. Colloid preload improved haemodynamic stability but did not affect neonatal outcome when arterial pressure was maintained with an infusion of metaraminol during spinal anaesthesia for Caesarean section.
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Randomized Controlled Trial Comparative Study Clinical Trial
Influence of equianaesthetic concentrations of nitrous oxide and isoflurane on regional cerebral blood flow, regional cerebral blood volume, and regional mean transit time in human volunteers.
Nitrous oxide and isoflurane have cerebral vasodilatory effects. The use of isoflurane in neuroanaesthesia is widely accepted, whereas the use of nitrous oxide in neuroanaesthesia is still the subject of debate. In the present study, contrast-enhanced magnetic resonance (MR) perfusion measurement was used to compare the effects of 0.4 MAC nitrous oxide (n=9) and 0.4 MAC isoflurane (n=9) on regional cerebral blood flow (rCBF), regional cerebral blood volume (rCBV) and regional mean transit time (rMTT) in spontaneously breathing human volunteers. ⋯ Isoflurane, by contrast, increased rCBF and rCBV in basal ganglia more than did nitrous oxide. An increased rMTT was caused by a relatively greater increase in rCBV than in rCBF supratentorially by isoflurane and infratentorially by nitrous oxide. In conclusion, nitrous oxide increases rCBF and rCBV predominantly in supratentorial grey matter, whereas isoflurane increases rCBF and rCBV predominantly in infratentorial grey matter.
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Randomized Controlled Trial Clinical Trial
Spinal anaesthesia with 0.5% hyperbaric bupivacaine in elderly patients: effects of duration spent in the sitting position.
Sixty patients, aged 65-84 yr, undergoing minor urological surgery under spinal anaesthesia remained sitting for 2 (group 1, n = 15), 5 (group 2, n = 15), 10 (group 3, n = 15), or 20 (group 4, n = 15) min after completion of the subarachnoid administration of 3 ml of a 0.5% hyperbaric bupivacaine solution. They were then placed in the supine position. Analgesia levels were assessed bilaterally using pinprick. ⋯ Twenty minutes after the injection the upper analgesia levels were lower (P<0.05) in group 4 (median T9.0) than in the groups 1-3 (medians T6.6-T8.5). The highest obtained levels (medians T5.7-T8.0) did not differ between the groups, but occurred later (P<0.05) in group 4 (median 35 min) than in groups 1-3 (medians 19-24 min). There were no significant differences in the maximum degree of motor block or haemodynamic changes between the four study groups.
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We present a case of a probably unnecessary Caesarean section due to misinterpretation of the cardiotocography (CTG) trace during general anaesthesia. A 27-yr-old patient in her 30th week of an uneventful, normal first pregnancy presented with a deep venous thrombosis in the pelvic region. She was to undergo an emergency thrombectomy under general anaesthesia. ⋯ The pH at delivery was 7.23 and the baby was extubated 2 days later. Mother and child recovered without short-term sequelae. In the absence of alternative explanations, reduced fetal beat-to-beat variability with a normal baseline heart rate during general anaesthesia is probably normal.