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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Randomized Controlled Trial Clinical Trial
Activation of electrocorticographic activity with remifentanil and alfentanil during neurosurgical excision of epileptogenic focus.
Opioids are known to stimulate surface electroencephalographic activity in patients with temporal lobe epilepsy. The objective of the current study was to compare the electrocorticographic activation effects of the newer short-acting opioid remifentanil with those of alfentanil during epilepsy surgery under general anaesthesia. ⋯ We conclude that at the doses used in this study, alfentanil is the better opioid for intraoperative activation of the ECoG in neurosurgical patients undergoing resection of a temporal lobe epileptic focus. This pharmacological activation of epileptiform activity assists in localizing and confirming the site of surgical excision. Neither alfentanil nor remifentanil activated epileptiform activity in non-epileptic brain tissue.
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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
Cardiovascular changes after the three stages of nasotracheal intubation.
Nasotracheal intubation typically comprises three distinct stages: (i) nasopharyngeal intubation; (ii) direct laryngoscopy to identify the vocal cords; and (iii) the passage of the tracheal tube into the trachea. The aim of this study was to identify and compare the cardiovascular responses associated with each of these stages. ⋯ Nasopharyngeal intubation causes a significant pressor response. Stimulation of the larynx and trachea by the passage of the tracheal tube, but not direct laryngoscopy, causes a significant increase in this response.