European journal of anaesthesiology
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Randomized Controlled Trial Comparative Study
Levobupivacaine and fentanyl for spinal anaesthesia: a randomized trial.
Levobupivacaine 0.5% and racemic bupivacaine 0.5% are equally effective in spinal anaesthesia. Fentanyl has been used as an adjunct to racemic bupivacaine in spinal anaesthesia. At the time this study was designed, there was no published study on the intrathecal use of 0.5% levobupivacaine with fentanyl. ⋯ We conclude that 2.3 mL of 0.5% levobupivacaine with fentanyl 15 microg is as effective as 2.6 mL of 0.5% levobupivacaine alone in spinal anaesthesia for urological surgery. Further studies may be directed to find the optimal combination of levobupivacaine and opioid with maximal haemodynamic stability and least motor block.
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Randomized Controlled Trial
Hyperbaric bupivacaine affects the doses of midazolam required for sedation after spinal anaesthesia.
Patients having spinal anaesthesia with hyperbaric bupivacaine may become sensitive to sedative drugs but no data exists about any dose-related effect of the local anaesthetic on the sedative requirement. We aimed to investigate whether hyperbaric bupivacaine dose in spinal anaesthesia has any effect on midazolam requirements. ⋯ Different doses of hyperbaric bupivacaine for spinal anaesthesia do not affect the midazolam requirements for sedation. However, spinal anaesthesia with hyperbaric bupivacaine with a maximum spread in the middle thoracic dermatomes may be associated with sedative effects and thus a reduced need for further sedation with midazolam.
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The tunnelling phase of ventriculoperitoneal shunt insertion is the most painful part but patients are often given inadequate opioid analgesic for fear of post operative delayed recovery and/or respiratory depression. This may result in an increase in intracranial pressure. ⋯ Tunnelling significantly increases intracranial pressure and blood pressure despite prior fentanyl administration. This may be deleterious in the presence of intracranial pathology.
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Inhalation induction with sevoflurane provides acceptable conditions for tracheal intubation. Opioids significantly decrease the alveolar concentration needed to achieve tracheal intubation. The purpose of this study was to determine the target concentration of remifentanil providing excellent conditions for tracheal intubation with sevoflurane at 1 minimum alveolar concentration without muscle relaxant. ⋯ Remifentanil at 3.3 ng mL(-1) together with sevoflurane at 1 minimum alveolar concentration provides excellent conditions for tracheal intubation in 50% of patients.
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A recent survey in the British Medical Journal reported the attitudes of orthopaedic surgeons towards the intraoperative death of a patient. Several replies to this article were from anaesthetists, who pointed out that other staff might be affected by 'death on the table'. We designed a questionnaire survey to assess the attitudes of anaesthetists, concerning intraoperative death. ⋯ This survey shows that anaesthetists are highly likely to experience intraoperative death, the consequences of which can be extremely stressful. Although the majority of anaesthetists (71%) agreed that it was reasonable for medical staff not to take part in operations for 24 h after an intraoperative death, fewer (25%) thought the proposal practicable. Nevertheless, all departments should provide for the discontinuation of further operations, if the circumstances require it. Consideration should be given by all departments of anaesthesia towards the prevention of intraoperative death, and the management of its aftermath, including the provision of support for psychologically traumatized staff.