Anaesthesia and intensive care
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Anaesth Intensive Care · Dec 1998
Case ReportsDifficult pulmonary artery catheterization in a patient with persistent left superior vena cava.
A persistent left superior vena cava is an uncommon congenital abnormality. It arises when the left anterior cardinal vein fails to regress during the embryonic period. ⋯ The anaesthetist may encounter difficulty in the insertion of pulmonary artery catheters. Other implications in the management of these patients in the operating theatre or intensive care unit are discussed.
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Autistic children are difficult to manage and there are no anaesthesia studies to suggest management strategies. We present five case reports which describe an integrated management program taking into account the special needs of autistic children and their families. ⋯ We also present a process to minimize the stress and problems inherent in the conventional admission process. Oral ketamine (6 to 7 mg/kg) has proven to be the most reliable preoperative sedative for these patients.
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Anaesth Intensive Care · Dec 1998
Randomized Controlled Trial Comparative Study Clinical TrialPatient-controlled epidural versus intravenous pethidine to supplement epidural bupivacaine after abdominal aortic surgery.
In a double-blind, randomized, crossover study of 25 patients after abdominal aortic surgery, we compared patient-controlled analgesia (PCA) with epidural versus intravenous pethidine. All patients received continuous epidural infusions of 0.125% bupivacaine adjusted to maintain appropriate sensory levels. The 48 hour study period commenced 36 to 48 hours after surgery and covered postoperative days 2 and 3. ⋯ Visual analog pain scores (VAS) did not differ significantly between postoperative days 2 and 3, or at rest between epidural and i.v. groups. However, VAS with coughing and with abdominal palpation were lower in the epidural PCA group (P = 0.05, 0.008). With a background epidural infusion of 0.125% bupivacaine, PCA with epidural pethidine provided better pain control than PCA intravenous pethidine and this was achieved at lower plasma pethidine concentrations.