British journal of anaesthesia
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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.
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Randomized Controlled Trial Clinical Trial
Pharmacokinetics of 0.75% ropivacaine and 0.5% bupivacaine after ilioinguinal-iliohypogastric nerve block in children.
Blockade of the ilioinguinal and iliohypogastric nerves is a useful procedure in paediatric patients undergoing inguinal surgery. Bupivacaine 2 mg kg-1 has been recommended for this block. We compared the plasma concentrations of ropivacaine and bupivacaine following an ilioinguinal-iliohypogastric block. ⋯ Bupivacaine is more rapidly absorbed from the injection site and leads to higher plasma concentrations than ropivacaine.
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Comparative Study
Pharmacological preconditioning: comparison of desflurane, sevoflurane, isoflurane and halothane in rabbit myocardium.
Recent investigations showed that isoflurane can induce pharmacological preconditioning. The present study aimed to compare the potency of four different halogenated anaesthetics to induce preconditioning. ⋯ Halothane, isoflurane and desflurane induced pharmacological preconditioning, whereas sevoflurane had no significant effect. In this preparation, desflurane was the most effective agent at preconditioning the myocardium against ischaemia.
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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.
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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.