British journal of anaesthesia
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Randomized Controlled Trial
Thoracic epidural analgesia or patient-controlled local analgesia for radical retropubic prostatectomy: a randomized, double-blind study.
Postoperative pain after radical retropubic prostatectomy is moderate to severe. The primary aim of this study was to assess whether intra-abdominal local anaesthetics provide similar analgesia compared with thoracic epidural analgesia (TEA). ⋯ TEA provides superior postoperative pain relief with better preservation of expiratory muscle strength compared with PCLA.
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Lidocaine with epinephrine is the most optimal solution for epidural top-up for emergency caesarean section. Adding fentanyl further speeds onset.
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Randomized Controlled Trial
Combined spinal and epidural anaesthesia and maternal intrapartum temperature during vaginal delivery: a randomized clinical trial.
We determined the association between combined spinal-epidural (CSE) anaesthesia and an increase in maternal intrapartum temperature and intrapartum fever. ⋯ The use of CSE is associated with a significant increase in maternal temperature and in the incidence of intrapartum maternal fever. However, the increase in maternal temperature does not appear to provoke any deleterious effects on the mother or child.
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There is a need for a bedside functional residual capacity (FRC) measurement method that performs well in intensive care patients during many modes of ventilation including controlled, assisted, spontaneous, and mixed. We developed a modified multiple breath nitrogen washout method for FRC measurement that relies on end-tidal gas fractions and alveolar tidal volume measurements as inputs but does not require the traditional measurements of volume of nitrogen or oxygen. Using end-tidal measurements, not volume, reduces errors from signal synchronization. This study was designed to assess the accuracy, precision, and repeatability of the proposed FRC system in subjects with variable ventilation patterns including some spontaneous effort. ⋯ The modified multiple breath nitrogen washout method for FRC measurement provides improved precision and equivalent accuracy and repeatability compared with existing methods during ventilation with variable ventilation patterns. Further study of the novel N₂ washout method is needed.