British journal of anaesthesia
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We present three cases of epidural abscess, all in patients in whom an epidural catheter had been inserted for postoperative pain management. In all three cases the infecting organism was Staphylococcus aureus and two patients had diabetes. ⋯ We have retrospectively calculated the incidence of epidural abscess in our hospital over the 5-yr period 1993-98 to be 1 in 800 (0.12%). We emphasize the importance of using techniques that minimize the risk of bacterial contamination during both catheter placement and the management of infusion, and seek to raise awareness of this relatively rare but significant condition.
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Comparative Study
Cerebral haemodynamics in pregnancy and pre-eclampsia as assessed by transcranial Doppler ultrasonography.
Altered cerebral circulation, as reported during normal pregnancy, and in patients with pre-eclampsia, can be associated with changes in cerebral vascular reactivity and/or cerebral autoregulation. The aim of our study was to perform a comparative assessment of cerebral haemodynamics, including vascular reactivity and autoregulation, in pre-eclamptic patients, healthy pregnant women, and healthy non-pregnant women. ⋯ Healthy pregnancy increases eCPP, presumably by decreasing CrCP. In pre-eclampsia, eCPP is maintained at the same level as in healthy pregnancy despite an increased MAP. Pre-eclampsia has no significant effect on cerebral autoregulation or CRCO(2).
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Defluorination of sevoflurane is catalysed by the hepatic enzyme cytochrome P450 2E1 (CYP2E1). Data about the ontogenesis (developmental variations in activity) of this enzyme suggest a low metabolism of sevoflurane during the first months of life. ⋯ These results suggest that, in children less than 48 months, sevoflurane metabolism parallels postnatal development of CYP2E1.
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Randomized Controlled Trial Comparative Study Clinical Trial
Spinal anaesthesia: comparison of plain ropivacaine 5 mg ml(-1) with bupivacaine 5 mg ml(-1) for major orthopaedic surgery.
Ropivacaine provides effective spinal anaesthesia for total hip arthroplasty. This study was designed to compare the efficacy and safety of plain ropivacaine with plain bupivacaine for spinal anaesthesia in patients undergoing total hip arthroplasty. ⋯ Intrathecal administration of either 17.5 mg plain ropivacaine or 17.5 mg plain bupivacaine was well tolerated and an adequate block for total hip arthroplasty was achieved in all patients. A more rapid postoperative recovery of sensory and motor function was seen in Group R compared with Group B.