Anaesthesia and intensive care
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Anaesth Intensive Care · Nov 1992
Randomized Controlled Trial Comparative Study Clinical TrialThe effect of epidural blockade on postoperative hypercoagulability following abdominal aortic bypass surgery.
The effect of epidural blockade on postoperative hypercoagulability was assessed in patients undergoing elective abdominal aortic bypass surgery. Twenty patients were randomised to receive general anaesthesia alone, or general anaesthesia plus thoracic epidural blockade with 0.5% bupivacaine. ⋯ Similarly, epidural blockade did not affect the postoperative decrease in antithrombin III. The results suggest that epidural blockade with local anaesthetic agents does not prevent the postoperative hypercoagulability response following abdominal aortic bypass surgery.
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Anaesth Intensive Care · Nov 1992
Randomized Controlled Trial Clinical TrialProphylactic intramuscular ephedrine prior to caesarean section.
Thirty healthy parturients, having given informed consent, were randomly allocated in a double-blind study to receive an intramuscular injection of either 0.9% sodium chloride (control), ephedrine 25 mg, or ephedrine 50 mg, 30 minutes prior to general anaesthesia for caesarean section. Nine patients (90%) in the 50 mg group and five patients (50%) in the 25 mg group demonstrated reactive hypertension of 20% or greater from control. The mean maximum increase in the 50 mg group was 28.2% (range 4.4-38.3%). ⋯ The associated increase in umbilical arterial base deficit suggests a metabolic component due to fetal asphyxia related to decreased uterine blood flow. We conclude that the prophylactic administration of intramuscular ephedrine prior to spinal anaesthesia is associated with an unacceptably high incidence of maternal hypertension, and should the spinal fail and general anaesthesia be required, also results in adverse neonatal biochemical changes. The technique is therefore not to be recommended.