Anaesthesia and intensive care
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Anaesth Intensive Care · Feb 1990
Randomized Controlled Trial Comparative Study Clinical TrialA double-blind comparison of epidural bupivacaine and bupivacaine-fentanyl for caesarean section.
The effect of adding fentanyl 100 mcg to bupivacaine 0.5% plain to establish epidural anaesthesia for elective caesarean section was investigated in a randomised, double-blind study of sixty healthy women. The quality of intraoperative analgesia as assessed by both patients and anaesthetists was significantly improved with fentanyl. The onset and duration of sensory anaesthesia, degree and duration of motor block, and other characteristics of epidural anaesthesia were unaltered. ⋯ The pharmacokinetics of epidural fentanyl administration were investigated by plasma fentanyl assays from maternal and cord blood taken at delivery. Epidural bupivacaine-fentanyl combination is a valuable therapeutic approach to the conduct of epidural anaesthesia for caesarean section in healthy women and foetuses. Further neonatal evaluation of the premature or compromised foetus is suggested before the universal application of this technique.
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Anaesth Intensive Care · Nov 1989
Randomized Controlled Trial Comparative Study Clinical TrialPost-cholecystectomy pulmonary function following interpleural bupivacaine and intramuscular pethidine.
Twenty-four patients who were to undergo cholecystectomy were randomised into two groups, one to receive postoperative analgesia with interpleural bupivacaine, 20 ml of a 0.5% solution with adrenaline 5 micrograms/ml, and the other to receive intramuscular pethidine, 1 mg/kg. Preoperative and postoperative pulmonary function, postoperative pain scores, and days from operation to hospital discharge were recorded and statistically compared. There was no significant difference in pain scores, nor in days to discharge; however, postoperative pulmonary mechanics were significantly poorer in the interpleural group. A hypothesis to explain the differences is offered.
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Anaesth Intensive Care · May 1989
Randomized Controlled Trial Clinical TrialEpidural morphine by the thoracic or lumbar routes in cholecystectomy. Effect on postoperative pain and respiratory variables.
Thirty-seven women undergoing elective cholecystectomy were randomised into two groups, receiving either lumbar epidural morphine (group L) or epidural morphine via the thoracic route (group T). The effect on pain relief was assessed by a visual analogue scale and included both resting pain and 'provoked' pain. ⋯ No significant difference was observed between the groups concerning pain relief or respiratory performance. We conclude that after cholecystectomy lumbar epidural morphine is as effective as thoracic epidural morphine in relieving postoperative pain.
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Anaesth Intensive Care · May 1989
Randomized Controlled Trial Clinical TrialMandatory minute volume weaning in patients with pulmonary pathology.
This study evaluates mandatory minute volume (MMV) weaning in patients with pulmonary pathology. When weaning criteria were fulfilled, 22 patients were randomised to MMV and 18 to a control intermittent mandatory ventilation (IMV) group. With IMV weaning the ventilator rate was decreased by two breaths per minute at 3-4 hourly intervals during daylight hours. ⋯ All weans were considered complete four hours after the cessation of mechanical support, and were deemed successful if no further ventilation was required. The success rate was 86% in the IMV and 89% in the MMV group. MMV weaning was rapid (4.75 + 1.5 hrs) and proved less demanding on the ICU staff by providing a safe trial of spontaneous respiration, while retaining the facility for partial ventilation.
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Anaesth Intensive Care · May 1989
Randomized Controlled Trial Comparative Study Clinical TrialEpidural pethidine or fentanyl during caesarean section: a double-blind comparison.
The onset, quality and duration of analgesia and side-effects of a single bolus dose of either epidural pethidine 50 mg or fentanyl 100 mcg, administered immediately post-delivery, were compared in a randomised, double-blind study of fifty-five women undergoing epidural caesarean section. The onset of effect was more rapid with fentanyl, a significantly larger number of women achieving complete pain relief fifteen minutes post-administration (P less than 0.05). ⋯ One patient in the pethidine group experienced early onset respiratory depression; however, she did not require active treatment. Epidural fentanyl 100 mcg appears to offer a small clinical advantage over pethidine 50 mg for intraoperative use during caesarean section.