European journal of anaesthesiology
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Randomized Controlled Trial Clinical Trial
EMLA cream reduces the pain of venepuncture in children.
EMLA cream (eutectic mixture of local anaesthetics) was tested in a double-blind clinical trial to examine its effect on the pain of venepuncture at induction of anaesthesia in 40 children (aged 3-13 yrs). Four pain-assessment methods were used and an assessment of the technical ease of venepuncture was made. EMLA was found to reduce significantly the pain and technical difficulty of venepuncture. This study confirms that EMLA is an effective method of reducing the pain and technical difficulty of paediatric venepuncture using 25-gauge needles for induction of anaesthesia in children.
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Randomized Controlled Trial Comparative Study Clinical Trial
Ventilatory CO2 response, respiratory drive and timing in children anaesthetized with halothane, enflurane or isoflurane.
Ventilatory CO2 response, respiratory drive and timing were investigated during anaesthesia prior to surgery in 24 spontaneously breathing cardiopulmonary healthy children. Anaesthesia was maintained with halothane, enflurane or isoflurane combined with oxygen-nitrous oxide (FIO2 0.5). The MAC values were 0.97 for halothane, 0.92 for enflurane and 0.92 for isoflurane. ⋯ End-tidal CO2 tensions were significantly higher during enflurane than during both halothane and isoflurane anaesthesia, before as well as during CO2 stimulation. Respiratory rates were lower in children anaesthetized with enflurane and were unresponsive to CO2 when all three volatile agents were used. During CO2 challenge, mean inspiratory flow and maximal occlusion pressure were similarly increased in all groups.
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Randomized Controlled Trial Comparative Study Clinical Trial
Intra- and post-operative blood loss and haemodynamics in total hip replacement when performed under lumbar epidural versus general anaesthesia.
The effects of lumbar epidural anaesthesia and two types of general anaesthesia on blood loss and haemodynamics during and after hip replacement were compared in three groups of patients. One group (n = 14) received continuous lumbar epidural anaesthesia, another group (n = 10) was given inhalational anaesthesia and spontaneous breathing after endotracheal intubation, and the third group (n = 14) received artificial ventilation after intubation and pancuronium and fentanyl intermittently i.v. Intra-operative blood loss in patients under epidural anaesthesia was 950 +/- 300 ml (mean +/- SD) and blood loss during the following 24 h-i.e. as long as the epidural anaesthesia was maintained-was 370 +/- 80 ml. ⋯ Intra-operatively, inhalational anaesthesia also induced hypotension on the arterial and venous sides compared with general anaesthesia using artificial ventilation. Post-operatively, the general anaesthesia groups behaved haemodynamically similarly and no differences in blood loss were seen. The reduction in blood loss, notably associated with lumbar epidural anaesthesia, is beneficial in decreasing the hazard and cost of blood transfusion.
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The benefits of epidural anaesthesia combined with general anaesthesia were studied in young children scheduled for major abdominal surgical procedure (pull-through for Hirschsprung's disease). Two groups of nine children were studied receiving, respectively, general anaesthesia or general anaesthesia plus epidural anaesthesia. In the group receiving both general and regional anaesthesia, a polyurethane 24 G catheter was inserted via a Tuohy needle 19 G into the lumbar epidural space after induction of anaesthesia and intubation and bupivacaine, 0.25%, was injected epidurally (mean initial volume 0.71 +/- 0.04 ml kg-1). ⋯ The need for blood replacement was also significantly lower, whereas pre- and post-operative haematocrit values were not significantly different. Administration of fluid and electrolytes during operation was also similar in both groups. A combination of epidural and general anaesthesia avoids the use of opiates during surgery, provides excellent per- and post-operative analgesia, allows a rapid and safe recovery, and facilitates the nursing of young children.
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Randomized Controlled Trial Comparative Study Clinical Trial Controlled Clinical Trial
Fentanyl and bupivacaine mixture for extradural blockade in orthopaedic surgery: effects on haemodynamic responses and pain related to the use of thigh tourniquet.
Analgesic and haemodynamic changes due to tourniquet application were investigated in a prospective double-blind study on orthopaedic patients submitted to extradural lumbar blockade with a bupivacaine and fentanyl mixture. The study was carried out in 161 healthy patients undergoing limb surgery with a thigh tourniquet. Patients were randomly assigned to two groups: each group received treatment with bupivacaine 0.5% containing 1:200,000 adrenaline. ⋯ A dramatic reduction in intra-operative supplemental analgesic needs was observed in the B:F 200 group. This group of patients also complained less of tourniquet pain than their counterparts, for the first 30 min of application. Our study underlines the value of fentanyl addition to bupivacaine in extradural blockade in orthopaedic surgery.