British journal of anaesthesia
-
Midlatency auditory evoked responses (MLAER) can distinguish different stages of anaesthesia. We studied MLAER during emergence from propofol/sufentanil anaesthesia in relation to recovery of explicit memory. ⋯ Large intra- and inter-individual variability in the MLAER values limited their ability to predict memory responses in individual patients during emergence from propofol/sufentanil anaesthesia.
-
Randomized Controlled Trial Clinical Trial
Comparison of intrathecal fentanyl and diamorphine in addition to bupivacaine for caesarean section under spinal anaesthesia.
Co-administration of small doses of opioids and bupivacaine for spinal anaesthesia reduces intraoperative discomfort and may reduce postoperative analgesic requirements in patients undergoing Caesarean section. Fentanyl and diamorphine are the two most frequently used agents in UK obstetric anaesthetic practice. ⋯ Both intrathecal opioids reduce intraoperative discomfort, but only diamorphine reduced postoperative analgesic requirement beyond the immediate postoperative period.
-
Comparative Study
Prediction of the haemodynamic response to tracheal intubation: comparison of laser-Doppler skin vasomotor reflex and pulse wave reflex.
The laser-Doppler skin vasomotor reflex (SVmR) caused by tetanic stimulation of the ulnar nerve may be a test that can predict the haemodynamic response to tracheal intubation. A decrease in pulse wave amplitude (pulse wave reflex, PWR) may be an alternative index of this response. We compared the abilities of PWR and SVmR to predict the haemodynamic response to tracheal intubation and studied how alfentanil, muscle relaxation, stimulation site and stimulation pattern affected the two reflexes. ⋯ An absent SVmR does not predict a blunted arterial pressure or heart rate response to tracheal intubation. The PWR may be a better predictor.
-
Accidental intrathecal injection of bupivacaine during epidural analgesia in labour remains a hazard, with the potential to cause total spinal anaesthesia and maternal collapse. Sacral block appears early after intrathecal injections compared with epidural ones, and we therefore used SI motor block to determine a safe and reliable test dose for epidural catheter misplacement. ⋯ We conclude that testing for SI motor block 10 min after epidural injection of bupivacaine 10 mg is a reliable test to detect accidental intrathecal injection in the obstetric population.