British journal of anaesthesia
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Review Meta Analysis
Patient-controlled epidural analgesia versus continuous infusion for labour analgesia: a meta-analysis.
Patient-controlled epidural analgesia (PCEA) is a relatively new method of maintaining labour analgesia. There have been many studies performed that have compared the efficacy of PCEA with continuous epidural infusion (CEI). The purpose of this systematic review is to compare the efficacy and safety of PCEA and CEI. ⋯ Patients who receive PCEA are less likely to require anaesthetic interventions, require lower doses of local anaesthetic and have less motor block than those who receive CEI. Future research should be directed at determining differences in maternal satisfaction and obstetric outcome.
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Randomized Controlled Trial Clinical Trial
Management of post-strabismus nausea and vomiting in children using ondansetron: a value-based comparison of outcomes.
This study evaluated the clinical efficacy and cost-effectiveness of prophylactic ondansetron versus early ondansetron treatment in the management of postoperative nausea and vomiting (PONV) in children undergoing strabismus repair using clinically meaningful outcomes and value-based principles. ⋯ Compared with early symptomatic treatment with ondansetron, prophylactic ondansetron shortened fast-tracking time and duration of PACU stay and improved parental satisfaction and therapeutic outcomes at a lower direct cost.
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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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Vasovagal episodes occur frequently in young healthy patients undergoing venous cannulation and loco-regional anaesthesia. We report two cases of severe coronary vasospasm and non-Q-wave infarction in healthy young women after administration of ephedrine for vasovagal symptoms at the onset of spinal anaesthesia. In the light of unopposed vagal predominance pre-disposing patients to coronary vasospasm, even in young healthy patients, atrophine and not ephedrine should be the first line treatment for bradycardia with or without hypotension under spinal anaesthesia.
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Rapid defibrillation is the most important intervention required for a patient in cardiac arrest due to ventricular fibrillation or ventricular tachycardia. Isolated case reports of spurious asystole may have seen a change in practice, moving away from monitoring through defibrillator paddles and gel pads in favour of attaching electrocardiograph (ECG) leads for the initial monitoring of a collapsed patient. We surveyed current preferences for initial monitoring and estimated the difference in time taken to deliver the first shock with the following three monitoring techniques: defibrillator paddles and gel pads, ECG leads and hands-free adhesive pads. ⋯ The current practice of monitoring through leads delays the time to deliver the first shock. We recommend that initial monitoring through leads be discontinued in favour of hands-free adhesive pads or defibrillator paddles/gel pads.