European journal of anaesthesiology
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Randomized Controlled Trial Clinical Trial
Oral ketamine premedication in children (placebo controlled double-blind study).
Ketamine 3-6 mg kg-1 given by mouth to paediatric patients for anaesthetic premedication was evaluated. Forty-three children, ages 2-9 years were randomly allocated to receive either ketamine (3 or 6 mg kg-1) or placebo (cola 0.2 mL kg-1). ⋯ These improvements were present with ketamine 3 mg kg-1 and 6 mg kg-1 in comparison with the placebo. We conclude that 3 mg kg-1 ketamine given by mouth to premedicate paediatric patients is as effective as 6 mg kg-1 but has a decreased incidence of side effects such as nystagmus and vomiting.
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Randomized Controlled Trial Clinical Trial
Maternal and fetal effects of adrenaline with bupivacaine (0.25%) for epidural analgesia during labour.
The use of adrenaline added to bupivacaine during epidural analgesia for labour is controversial. The effects of epidural analgesia with bupivacaine containing adrenaline on maternal blood pressure and heart rate, uterine activity, progress of labour, fetal heart rate and Apgar scores, were assessed using visual analogue pain scores, upper level of sensory block and motor blockade in 60 parturients who were allocated randomly to receive: 10 mL of bupivacaine 0.25% plain (group I) or with adrenaline 5 micrograms mL-1 (group II) or with adrenaline 1.66 micrograms mL-1 (group III). ⋯ It is concluded that adrenaline at 5 micrograms mL-1 significantly prolongs the first stage of labour. Neither adrenaline 5 micrograms mL-1 nor 1.66 micrograms mL-1 has any beneficial effect.
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Randomized Controlled Trial Clinical Trial
Volume replacement with gelatin or hydroxyethylstarch solutions does not impair somatosensory evoked potential monitoring: a haemodilution study in conscious volunteers.
The influence of haemodilution with colloids on somatosensory evoked potentials in non-premedicated volunteers is reported. In seven volunteers (randomized crossover design), blood (20 mL kg-1 within 30 min) was removed and simultaneously replaced by gelatin 3% or hydroxyethylstarch 6%. After 30 min, blood was retransfused within 30 min. ⋯ Retransfusion increased haematocrit to 34.4 +/- 0.9% (gelatin) and to 34.2 +/- 1.3% (hydroxyethylstarch). Neither haemodilution with gelatin nor haemodilution with hydroxyethylstarch or retransfusion influenced evoked potentials. In conclusion, the treatment of blood loss up to 30% of estimated blood volume with gelatin or hydroxyethylstarch will not affect somatosensory evoked potential monitoring provided normovolaemic conditions are maintained.
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The facial nerve is monitored intra-operatively using electromyography to identify and prevent damage during the excision of an acoustic neurinoma. In order to determine whether a profound level of peripheral neuromuscular blockade could be achieved without compromising facial electromyographic monitoring, 11 patients undergoing resection of acoustic neurinoma were studied. ⋯ The facial nerve was directly stimulated in the surgical field and the facial evoked muscle potentials (EMPs) were recorded. Even under complete peripheral neuromuscular blockade (i.e. no electrically evoked muscle potential measurable over the hypothenar eminence, no palpable hypothenar muscle response) it was possible to evoke facial muscle electromyographic responses by stimulation of the facial nerve.
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There has been controversy over whether forward blood flow during closed-chest cardiopulmonary resuscitation (CPR) is generated by a general increase in intrathoracic pressure (chest-pump theory) or by creating atrioventricular gradients that close the mitral valve and open the aortic valve during thoracic compression (cardiac pump theory). The crucial issue is the position of the mitral valve during the downstroke of chest movement. Questions remain over the actual mechanics of mitral and aortic valve function. This report describes an intraoperative cardiac arrest followed by CPR during which routinely instituted two-dimensional transoesophageal Doppler echocardiography enabled study of the motion of the valves of the left heart and the transmitral blood flow.