Anaesthesia and intensive care
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Anaesth Intensive Care · Jul 2011
Comparative StudyComparison of predicted and perceived pain from epidural and spinal puncture in patients undergoing elective caesarean section.
The intensity of pain expected by patients before an epidural and/or a spinal puncture is uncertain. The main purpose of this study was to identify and compare the intensity of pain predicted and perceived by patients having an epidural and a spinal procedure. After screening for relevant exclusion criteria, 50 women who were undergoing elective caesarean section under combined spinal-epidural anaesthesia (double-segment technique) were enrolled in the study. ⋯ Predicted pain for epidural and spinal insertion (epidural 60.6 +/- 20.5 mm, spinal: 55.1 +/- 24 mm) was significantly higher than the pain perceived (epidural 36.3 +/- 20 mm, spinal 46.1 +/- 23.2 mm) (epidural P < 0.001, spinal P = 0.031). Patients who were scheduled for an elective caesarean section under combined spinal-epidural anaesthesia predicted 1.2- to 1.7-fold stronger pain intensity than they perceived during the procedure. Patients should be informed that a regional anaesthetic, especially epidural, procedure is often less painful than the patient's expectation.
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Anaesth Intensive Care · Jul 2011
Randomized Controlled TrialEffect of epidural levobupivacaine on recovery from vecuronium-induced neuromuscular block in patients undergoing lower abdominal surgery.
The aim of this study was to evaluate the effect of epidural levobupivacaine on recovery from vecuronium-induced neuromuscular block. Ninety patients undergoing lower abdominal surgery were randomised into two groups after an epidural test dose: the epidural group (n = 45) received a bolus of 15 ml of 0.5% levobupivacaine whereas the control group (n = 45) did not. Anaesthesia was induced and maintained with propofol, fentanyl, vecuronium and nitrous oxide. ⋯ The times of the recovery index (the time from 25% to 75% recovery of T1) and of the DUR 25-train-of-four 90 (time from 25% T1 to train-of-four ratio of 0.9) in the epidural group were significantly longer than those for the control group (5.2 [2.1] vs 3.04 [1.02] minutes and 10.8 [3.3] vs 8.2 [2.3] minutes, P < 0.001). This study shows that epidural levobupivacaine significantly delays the train-of-four recovery from vecuronium-induced block. Although the interaction is small in the clinical setting, anaesthetists should take this interaction into consideration when combining general and epidural anaesthesia during surgery.
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Anaesth Intensive Care · Jul 2011
Comparative StudyComparison of actual tidal volume in neonatal lung model volume control ventilation using three ventilators.
In neonates, small changes in tidal volumes (V(T)) may lead to complications. Previous studies have shown a significant difference between ventilator-measured tidal volume and tidal volume delivered (actual V(T)). We evaluated the accuracy of three different ventilators to deliver small V(T) during volume-controlled ventilation. ⋯ V(TV) of the EV4N in the normal and the injured models (37.8 ml and 46.6 ml) were markedly increased compared with set V(T), and actual V(T) were similar to set V(T) in the normal and injured model (30.2 ml and 31.9 ml, respectively). EV4N measuring V(T) close to the lung could match actual V(T) to almost the same value as the set V(T) however the gas volume of the breathing circuit was increased. If an accurate value for the patient's actual V(T) is needed, this V(T) must be measured by a sensor located between the Y-piece and the tracheal tube.
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Anaesth Intensive Care · Jul 2011
Historical ArticleChloroform for the King? Joseph Clover, Henry Thompson and the King of the Belgians.
In May 1863 the British surgeon, Henry Thompson, departed for Belgium to attend Leopold, King of the Belgians. The King was in agony: he had suffered with bladder stones for months and multiple procedures, without anaesthesia, had failed to relieve his symptoms. Henry Thompson was therefore consulted about the possibility of operating under the influence of chloroform. ⋯ History records that the successful operation was performed under chloroform anaesthesia administered by Joseph Clover. But a letter from Henry Thompson, discovered in Clover's personal papers, raises a number of questions about this operation. This was the procedure that made Henry Thompson rich and famous, but was it actually performed under anaesthesia? And if not, why not?