British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of the effects of intrathecal ropivacaine, levobupivacaine, and bupivacaine for Caesarean section.
Intrathecal ropivacaine is roughly dose equivalent to bupivacaine at a ratio of 1.5:1 ropivacaine:bupivacaine.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Patient well-being after general anaesthesia: a prospective, randomized, controlled multi-centre trial comparing intravenous and inhalation anaesthesia.
The aim of this study was to assess postoperative patient well-being after total i.v. anaesthesia compared with inhalation anaesthesia by means of validated psychometric tests. ⋯ Total i.v. anaesthesia improves early postoperative patient well-being and reduces the incidence of PONV.
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Spinal anaesthesia developed in the late 1800s with the work of Wynter, Quincke and Corning. However, it was the German surgeon, Karl August Bier in 1898, who probably gave the first spinal anaesthetic. Bier also gained first-hand experience of the disabling headache related to dural puncture. ⋯ In the last 50 yr, the development of fine-gauge spinal needles and needle tip modification, has enabled a significant reduction in the incidence of post-dural puncture headache. Though it is clear that reducing the size of the dural perforation reduces the loss of CSF, there are many areas regarding the pathogenesis, treatment and prevention of post-dural puncture headache that remain contentious. How does the microscopic pattern of collagen alignment in the spinal dura affect the dimensions of the dural perforation? How do needle design, size and orientation influence leakage of CSF through the dural perforation? Can pharmacological methods reduce the symptoms of post-dural puncture headache? By which mechanism does the epidural blood patch cure headache? Is there a role for the prophylactic epidural blood patch? Do epidural saline, dextran, opioids and tissue glues reduce the rate of CSF loss? This review considers these contentious aspects of post-dural puncture headache.
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Randomized Controlled Trial Clinical Trial
Sequential compression device with thigh-high sleeves supports mean arterial pressure during Caesarean section under spinal anaesthesia.
This study investigated the use of a Sequential Compression Device (SCD) with thigh-high sleeves and a preset pressure of 50 mm Hg that recruits blood from the lower limbs intermittently, as a method to prevent spinal hypotension during elective Caesarean section. Possible association of arterial pressure changes with maternal, fetal, haemodynamic, and anaesthetic factors were studied. ⋯ SCD use in conjunction with vasopressor significantly reduced the incidence of a 20% reduction of MAP.
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Randomized Controlled Trial Comparative Study Clinical Trial
Randomized comparison of the classic Laryngeal Mask Airway with the Airway Management Device during anaesthesia.
We compared the modified Airway Management Device (AMD) with the classic Laryngeal Mask Airway (cLMA) in a randomized comparative trial. ⋯ Successful insertion of the cLMA is more likely than that of the AMD. Insertion of the AMD required more attempts and caused a greater number of complications. Fibre-optic position was poorer than with the cLMA. When an airway is established, the AMD caused a greater number of complications during anaesthesia and failed more frequently than the cLMA. During recovery from anaesthesia, more complications occurred with the AMD. Overall performance of the AMD was poorer than with the classic LMA.