South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde
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Clinical Trial Controlled Clinical Trial
Pruritus--a side-effect of epidural fentanyl for postoperative analgesia.
The side-effect of pruritus was studied in 31 patients receiving epidural fentanyl 100 micrograms in 8 ml normal saline for postoperative analgesia. A control group of 30 patients received pethidine 1,5 mg/kg 4-6-hourly as required. Thirteen per cent of the patients who received epidural fentanyl experienced pruritus. However, this incidence was not considered unacceptable and the pruritus was mild and of short duration.
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Total hip replacement was carried out on 22 patients under general anaesthesia. Of these, 10 were pretreated with methylprednisolone (30 mg/kg); 1 of these developed the adult respiratory distress syndrome (ARDS) and had high levels of thromboxane B2 (TXB2) 5 minutes after fixation of the femoral prosthesis and at the end of the operation. The other 12 patients served as controls; 5 of them developed ARDS and had statistically significant higher TXB2 levels than the other 7 control patients who remained well. ⋯ There was no statistical difference in 6-keto-PGF1 alpha levels between the patients who developed ARDS and those in the control group who remained well. Steroids reduce arachidonic acid metabolism by inhibiting the release of substrate for cyclo-oxygenase and lipoxygenase activity. Patients prone to ARDS thus benefit from methylprednisolone administration.
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A survey was undertaken to investigate the fate after discharge of 41 patients admitted to Groote Schuur Hospital, Cape Town, after a cerebrovascular accident. The period of hospitalization, functional capacity after discharge and support received from community-based support agencies were analysed. Major deficiencies in the long-term management of such patients are stressed.
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A survey was undertaken to investigate the ability of 104 subjects with locomotor disability to cope in their homes. Factors which might affect coping, such as age, race, sex and type of disease, were assessed. ⋯ The majority of the subjects appeared to be isolated from health personnel after discharge from hospital and to be restricted to their homes. The deficits in the local health services which contributed to this situation are stressed.
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A 27-year-old White woman with syringomyelia underwent a caesarean section. The pre-operative preparation and anaesthetic management are presented, and the specific problems discussed.