British journal of anaesthesia
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The results of 324 Caesarean sections conducted under lumbar extradural block are discussed. In addition to pre-loading with fluid i.v. and the avoidance of aorto-caval compression, more recent modifications have been to administer bupivacaine in incremental doses, to be less concerned with the size of the total dose, and to provide the mother with supplementary oxygen until delivery. ⋯ The technique has many advantages for both mother and infant and with a good obstetric service, few disadvantages. Prolongation of the interval between incision of the myometrium and delivery appears to be less detrimental to the infant than is the case when general anaesthesia is used.
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The 119 patients who had undergone previous Caesarean section lumbar extradural block was administered to 77 (65%); the other 42 (35%) received analgesia with ketobemidone 0.8-1.0 ml i.m. or nitrous oxide in oxygen intermittently, or both. Controlled i.v. infusion of oxytocin for induction or acceleration of labour was given to 77% in the extradural group and to 40% in the other group. In both groups 88% were delivered per vaginam. In two patients the uterine scar ruptured; both had received oxytocin during extradural block.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of i.m. lysine acetylsalicylate and oxycodone in the treatment of pain after operation.
Lysine acetylsalicylate (LAS) is a soluble salt of acetylsalicylic acid and can be given parenterally. LAS 12.5 mg kg-1 and 25 mg kg-1 were compared with oxycodone 0.15 mg kg-1 in the treatment of pain after operation in 60 patients undergoing varicose vein surgery. ⋯ No significant differences were found between the smaller and larger doses of LAS, suggesting a plateau effect. Further clinical experiments with LAS using i.v. mode of administration and other pain models are warranted.
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Randomized Controlled Trial Comparative Study Clinical Trial
Effect of baricity on spinal anaesthesia with amethocaine.
Amethocaine 1% solution was mixed with equal volumes of water, 0.9% saline or 10% dextrose to prepare respectively, hypobaric, isobaric and hyperbaric solutions which were compared for intradural spinal anaesthesia in 60 patients. Thirty patients received 10 mg and 30 patients received 15 mg of amethocaine. Injections were made with the patients in the lateral recumbent position and the operating table was horizontal during and after injection. ⋯ The mean spread of analgesia after the hyperbaric solution was five dermatomes greater than after the other two solutions, but the extent of analgesia was not significantly different whether amethocaine 10 mg or 15 mg was injected. The mean duration of analgesia after the hyperbaric solution was 285 min compared with 332 min and 360 min after the isobaric and hypobaric solutions respectively. The mean duration of analgesia after amethocaine 15 mg was significantly greater than after 10 mg.
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The perioperative course of three patients with obstructive sleep apnoea who underwent tracheotomy is presented as illustrative of the potentially life-threatening complications of management. It is concluded that this disease demands strict adherence to basic principles of airway management and close observation extending into the period after operation.