British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Effect of posture during the induction of subarachnoid analgesia for caesarean section. Right v. left lateral.
Thirty-five women scheduled for elective Caesarean section were randomly assigned to have subarachnoid analgesia induced in either the right or left lateral position. They were then turned supine with a wedge under the right hip. No patient in the right-sided group required further analgesia. Five patients in the left-sided group required postural manipulation to encourage the spread of analgesia and two required supplementary analgesia (P less than 0.01).
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Randomized Controlled Trial Comparative Study Clinical Trial
Subarachnoid analgesia for caesarean section. A double-blind comparison of plain and hyperbaric 0.5% bupivacaine.
Equal volumes (2.5 ml, 12.5 mg) of plain 0.5% bupivacaine (glucose-free) and hyperbaric 0.5% bupivacaine (in 8% glucose) were compared in a randomized double-blind study of 40 patients undergoing Caesarean section under subarachnoid anaesthesia. There were no differences in the rate of onset, maximum spread, number of patients with high cervical levels, duration of anaesthesia or incidence of post-spinal headaches between the two solutions. ⋯ Thirteen patients in the hyperbaric group and 10 in the isobaric group required i.v. ephedrine to treat hypotension. Nine patients (23%) developed a post-spinal headache, and three were treated with an extradural blood patch.
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Randomized Controlled Trial Comparative Study Clinical Trial
Anaesthesia for evacuation of retained products of conception. Comparison between alfentanil plus etomidate and fentanyl plus thiopentone.
Forty-four patients presenting for evacuation of retained products of conception were anaesthetized with either fentanyl and thiopentone, or alfentanil with etomidate, along with 70% nitrous oxide in oxygen. There was no difference between the two techniques in indices of immediate recovery (time to opening eyes and obeying a simple command), but the rate of return of higher mental functions (assessed by a coin counting test) was significantly better using the alfentanil-etomidate technique. There was no statistically significant difference between the techniques for apnoea or abnormal movements during anaesthesia, but alfentanil with etomidate was associated with significantly more pain on injection and a higher frequency of postoperative vomiting (40%).
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Randomized Controlled Trial Comparative Study Clinical Trial
Haemodynamic effects of vecuronium, pancuronium and atracurium in patients with coronary artery disease.
Thirty patients with ischaemic heart disease scheduled for coronary artery bypass grafting were randomly allocated to three equal groups. Following morphine, hyoscine and pentobarbitone premedication, anaesthesia was induced with diazepam 0.3 mg kg-1. Five minutes later neuromuscular blockade was induced with pancuronium 0.1 mg kg-1, vecuronium 0.1 mg-1 or atracurium 0.5 mg kg-1, followed after 6 min by fentanyl 25 micrograms kg-1. ⋯ Systemic vascular resistance decreased significantly from 1515 dyn s cm-5 to 1200 dyn s cm-5 following atracurium. Cardiac index was increased transiently in the atracurium group, but a more sustained increase was observed following pancuronium. Nine patients in the atracurium group showed skin flushing and one developed skin weals.
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Randomized Controlled Trial Comparative Study Clinical Trial
Effect of gravity on the spread of extradural anaesthesia for caesarean section.
The effect of gravity on the spread of extradural anaesthesia was evaluated in a series of parturients undergoing elective Caesarean section. Following placement of an extradural catheter, 25 patients were placed 30-40 degrees head-up for 20 min during the administration of the local anaesthetic drug; 25 additional patients remained supine during injection. ⋯ There were no differences in the rate of onset of sacral blockade or in the extent of neural blockade between the two groups. The semi-upright position was not necessary to ensure adequate sacral anaesthesia for Caesarean section.