Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparative study of patient controlled epidural analgesia (PCEA) and continuous infusion epidural analgesia (CIEA) during labour.
In a randomised, single-blinded, placebo-controlled study, 27 parturients in labour receiving epidural 0.125 per cent bupivacaine, were assessed to evaluate the efficacy of patient-controlled epidural analgesia (PCEA) compared with continuous infusion epidural analgesia (CIEA). Group A (n = 14) received a background infusion of 4 ml.hr-1 0.125 per cent bupivacaine, with further 4 ml aliquots, self-administered, as required (up to 16 ml.hr-1). Group B (n = 11) received a continuous infusion of 12 ml.hr-1 through the same PCA apparatus, but with the demand-button deactivated. ⋯ Pain relief was similar in both groups. Patients expressed overall satisfaction with PCEA, appreciating control over their own pain relief and less reliance on medical staff. PCEA is a safe, effective means of providing optimal analgesia during labour, with minimal local anaesthetic requirement.
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A case is presented which describes the initiation of atrial-ventricular (A-V) sequential pacing using atrial epicardial wires and an in-situ transluminal ventricular pacing probe. A 68-year-old female with a permanent A-V sequential pacemaker was scheduled for elective aortocoronary bypass. Following sternotomy, pacing function was converted to ventricular pacing (VVI) with the use of electrocautery. ⋯ Pacing was achieved at routine generator output settings of seven milliamps (mA) for both atrium and ventricle and at an A-V interval of 0.120 sec. This resulted in an immediate increase in cardiac output from 3.3 to 4.1 L.min-1. The compatibility of these two pacing systems offers an increased margin of safety in cardiac surgery patients requiring atrial pacing, who are at risk for developing postoperative heart block.