British journal of anaesthesia
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Letter Case Reports
Acute dystonia in a 14-yr-old following propofol and fentanyl anaesthesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Randomized controlled comparison of epidural bupivacaine versus pethidine for analgesia in labour.
We compared the incidence of Caesarean delivery in nulliparous women randomized to receive epidural analgesia with those randomized to intramuscular (i.m.) pethidine. On admission to the delivery suite in established labour, 802 nulliparae had already agreed to be randomized with respect to their first analgesia. One hundred and eighty-eight women required either no analgesia or 50% nitrous oxide in oxygen (Entonox) only. ⋯ The intention-to-treat analysis showed similar Caesarean section rates in those randomized to epidural (12%) or pethidine analgesia (13%). The difference in Caesarean rate was -1.1% with 95% confidence intervals from -6.3% to +4.1%. The normal vaginal delivery rates were similar (epidural, 59%; pethidine, 61%).
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of ketamine and morphine for analgesia after tonsillectomy in children.
In a double blind study we compared the effects of i.m. ketamine with morphine on postoperative analgesia in children undergoing tonsillectomy. Eighty children (aged 6-15 yr) were randomized to receive either i.m. morphine 0.1-0.15 mg kg-1 or ketamine 0.5-0.6 mg kg-1, after induction of a standard general anaesthetic. ⋯ There were no differences in supplemental analgesia requirements, or the incidence of vomiting or dreaming between the groups. We conclude that ketamine 0.5 mg kg-1 i.m. may be an alternative analgesic for children undergoing tonsillectomy.
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Randomized Controlled Trial Clinical Trial
Epidural ropivacaine with fentanyl following major gynaecological surgery: the effect of volume and concentration on pain relief and motor impairment.
In a prospective, randomized, double-blind study, 40 patients undergoing gynaecological oncology surgery received either 0.1% ropivacaine with fentanyl 1 microgram ml-1 or 0.2% ropivacaine with fentanyl 2 micrograms ml-1. A PCEA pump was set to deliver ropivacaine 8 mg with fentanyl 8 micrograms with each successful demand and a lockout period of 15 min without background infusion. Patients were observed for rest and activity pain VAS, side effect incidence, peak expiratory flow rate (PEFR), leg strength, sensory block to cold and pinprick, and PCEA usage into the second postoperative day. ⋯ There was a 24% increase in total drug used in the high-concentration/low-volume group (P < 0.05). The study demonstrated that PCEA ropivacaine with fentanyl is an effective means of postoperative analgesia for this patient population. Reduced drug consumption with high-volume/low-concentration solution confirms similar findings by other investigators using alternate local anaesthetic agents, and suggests that the therapeutic ratio of ropivacaine is widened if a low-concentration/high-volume solution is used.
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Case Reports
Successful resuscitation from recurrent ventricular fibrillation secondary to butane inhalation.
Resuscitation from cardiac arrest caused by volatile substance abuse is rarely successful. Large doses of catecholamines given during resuscitation, in the presence of butane, may cause recurrent ventricular fibrillation. ⋯ Cardiac output was restored 10 min after the administration of intravenous amiodarone. We suggest that antiarrhythmic agents should be used early during resuscitation to prevent recurrent arrhythmias.