British journal of anaesthesia
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The obstetric and anaesthetic problems of Ehlers-Danlos syndrome are discussed. A new unclassified type of the syndrome is described. ⋯ The anaesthetic management of two parturients with Ehlers-Danlos syndrome is illustrated. Caudal, extradural, and subarachnoid block techniques for labour and Caesarean section were used safely on three occasions in these two patients.
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Comparative Study
Differential nerve block by bupivacaine and 2-chloroprocaine. An experimental study.
The differential blocking effect of bupivacaine and 2-chloroprocaine was studied on isolated rabbit cervical sympathetic trunks (B and C fibres) and phrenic nerves (A fibres). The B fibres (myelinated, preganglionic) were more sensitive than C fibres (unmyelinated, postganglionic) to nerve block by bupivacaine and 2-chloroprocaine, as assessed by changes in action potential amplitude and latency. The blocking action of both bupivacaine and 2-chloroprocaine caused a decrease in amplitude in the B fibres approximately twice as great as that produced in the C fibres. ⋯ The average action potential amplitude of A fibres at that time was 78%. 2-Chloroprocaine 300 mumol litre-1 completely blocked B fibres in 4 min and C fibres in 15 min. At 15 min the average action potential amplitude of the A fibres was still approximately 35%. Although these two local anaesthetics differ structurally and physico-chemically, the rates of block of the different fibres were in the same order in vitro.
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Comparative Study
Respiratory effects of a new opiate analgesic, R 39209, in the rabbit: comparison with fentanyl.
The respiratory effects of R 39209, a new short-acting analgesic, were studied and compared with those of fentanyl, in the rabbit. Minute volume, respiratory frequency and pH, PCO2 and standard bicarbonate of arterialized venous blood were measured. ⋯ Fentanyl was between 2 and 3.5 times more potent than R 39209. Repeated doses of R 39209 produced reproducible peak effects even when only 10 min was allowed between administrations.
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Randomized Controlled Trial Comparative Study Clinical Trial
Effects of concentration of local anaesthetic drugs in extradural block.
An increase in the concentration of bupivacaine from 0.5% to 0.75% and etidocaine from 1.0% to 1.5% for extradural block resulted in a more rapid onset of sensory analgesia and motor blockade, a greater frequency of adequate analgesia,a greater depth of motor block and a longer duration of sensory analgesia and motor blockade. An increase in the concentration of prilocaine from 2% to 3% failed to reveal any significant advantage. The use of the more concentrated solutions of bupivacaine and etidocaine would appear to afford significant clinical advantages in extradural anaesthesia for surgery.