Anaesthesia and intensive care
-
Anaesth Intensive Care · May 1991
Randomized Controlled Trial Clinical TrialThe influence of epidural pethidine on shivering during lower segment caesarean section under epidural anaesthesia.
A prospective study of 94 patients undergoing elective lower segment caesarean section under epidural anaesthesia was performed in order to determine the incidence of shivering and the influence of epidural pethidine. Epidural anaesthesia was established with bupivacaine 0.5% with adrenaline, with or without additional lignocaine 2% with adrenaline, to total 20-25 ml. With the injection of epidural local anaesthesia an extra 5 ml of solution was administered into the epidural space--pethidine 25 mg preservative-free, in normal saline, or normal saline alone. ⋯ The difference was highly significant (P less than 0.01). There was no significant difference in the incidence of maternal nausea, vomiting, drowsiness or pruritus, or neonatal Apgar scores. Cord blood samples were assayed for pethidine, revealing low or absent pethidine concentrations.
-
Anaesth Intensive Care · Feb 1991
Randomized Controlled Trial Clinical TrialEpidural analgesia in labour: constant infusion plus patient-controlled boluses.
A randomised, single-blind study to investigate patient-controlled epidural analgesia during labour was conducted using a solution of low-dose bupivacaine-fentanyl. Two groups (n = 25 in each) received a constant infusion supplemented by patient demand boluses, and midwife-administered boluses if required, the size of the infusion and patient increments varying between groups. The quality of analgesia, as assessed by pain scores and patient ratings, was high and participant acceptability very high in both groups. ⋯ Significantly greater pain relief (P less than 0.04) three hours after commencing patient-controlled epidural analgesia and a trend to fewer women requiring more than two supplementary midwife-administered boluses (P = 0.11) was seen in the group receiving a higher infusion rate. This group used significantly more bupivacaine (P less than 0.04) and fentanyl (P less than 0.001), but this did not appear to be clinically important with respect to degree of motor block or side-effects. Patient-controlled epidural analgesia appears to be an effective and well accepted method of obstetric analgesia and warrants further investigation.
-
Anaesth Intensive Care · Nov 1990
Randomized Controlled Trial Comparative Study Clinical TrialThe addition of fentanyl to epidural bupivacaine in first stage labour.
Epidural analgesia was studied in 100 healthy Chinese women with uncomplicated pregnancies in first stage labour. Patients were randomly allocated to receive 8 ml of one of the following five solutions: bupivacaine 0.125% with fentanyl 50 micrograms or fentanyl 100 micrograms, bupivacaine 0.25% plain, bupivacaine 0.25% with fentanyl 50 micrograms or fentanyl 100 micrograms. ⋯ There was no difference in method of delivery or neonatal Apgar scores. The least concentrated mixture providing good quality analgesia for the first stage of labour was the combination of bupivacaine 0.125% with fentanyl 50 micrograms.
-
Anaesth Intensive Care · Nov 1990
Randomized Controlled Trial Clinical TrialUnlimited clear fluid ingestion two hours before surgery in children does not affect volume or pH of stomach contents.
To determine the effect on gastric contents of unlimited clear fluid ingestion by children up to two and a half hours and then up to two hours before elective surgery, 228 healthy children (ages two to twelve years) were prospectively studied. During Phase I of this study subjects ingested unrestricted volumes and types of clear fluids up to three hours (control group) or two and a half hours before surgery. After establishment of adequate anaesthesia, gastric fluids were aspirated via an orogastric tube. ⋯ The methods for Phase II were unchanged except that unlimited clear fluids were permitted up to three hours (control group) or two hours preoperatively. In both Phase I and II, gastric volume and gastric pH were unaffected by reducing the fast to less than three hours. It is concluded that ingestion of unlimited clear fluids up to two hours before elective surgery does not affect gastric contents of healthy children.
-
Anaesth Intensive Care · May 1990
Randomized Controlled Trial Comparative Study Clinical Trial Controlled Clinical TrialThe haemodynamic effects of propofol and thiopentone for induction of caesarean section.
Forty Chinese women for elective caesarean section received either propofol 2 mg.kg-1 or thiopentone 4 mg.kg-1 for induction of general anaesthesia. Systolic, mean and diastolic arterial pressures and heart rate were recorded non-invasively every minute for ten minutes. Post-induction arterial pressures were similar to pre-induction values with no differences between thiopentone and propofol. ⋯ At caesarean section, induction with propofol causes less variation in arterial pressure than thiopentone. Hypotension is probably prevented by the coincident stimulus of rapid sequence induction. Neonatal Apgar scores were similar between the two groups.