Anaesthesia
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Randomized Controlled Trial Clinical Trial
Epidural fentanyl and 0.5% bupivacaine for elective caesarean section.
Either 100 micrograms fentanyl or 2 ml saline was added to 0.5% bupivacaine administered epidurally for elective Caesarean section in 30 patients, in a double-blind randomised study. Bupivacaine 0.5% was administered until a complete sensory block was established extending to the 4th thoracic dermatome. ⋯ Postoperative analgesia was of longer duration in those who received epidural fentanyl (p less than 0.01). There were no deleterious effects on neonatal or maternal outcome.
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Seventy-four patients received general anaesthesia for Caesarean section. Seven percent of the elective group and 28% of the emergency patients reported dreaming or recall of voices during the procedure (p less than 0.05) at postoperative interview. One patient from each group reported feeling pain or suffocation. ⋯ A value greater than 13 mmHg picked up all patients who dreamed, with a false positive rate of 68%. Both of the 'aware' patients had provoked lower oesophageal contractility response of greater than 70 mmHg, an attribute shared by only 8% of the rest. The isolated forearm was particularly ineffective.
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A circle breathing system was connected by deadspace tubing to an open system valveless ventilator. The minimum volume of this tubing, required to prevent dilution of anaesthetic gas in the breathing system by the driving gas of the ventilator, was determined at frequencies of 15, 30, 60, 100 and 150 breaths/minute, with tidal volumes that ranged from 100 to 1100 ml and a fresh gas supply to the circle system of 1, 2 and 4 litres/minute. ⋯ Mixing of gas occurred in the system at frequencies greater than 30 breaths/minute even when the tidal volume was much less than the deadspace volume. However, at high frequencies of ventilation, since the tidal volume requirement decreases, deadspace tubing with a safe internal volume, that is greater than 600 ml, may be used up to 100 breaths/minute.
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Randomized Controlled Trial Comparative Study Clinical Trial
The effect of diclofenac and nefopam on postoperative dental pain.
Eighty-two outpatients who received general anaesthesia for surgical removal of maxillary or mandibular third molars were given either diclofenac 75 mg or nefopam 20 mg intramuscularly for postoperative pain control. They and the control group were also allowed oral paracetamol as required. The results showed that there was no significant pain relief from these single intramuscular injections.
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Randomized Controlled Trial Clinical Trial Controlled Clinical Trial
The effect of diltiazem on the cardiovascular response to tracheal intubation.
The efficacy of diltiazem in the attenuation of the cardiovascular response to laryngoscopy and tracheal intubation was studied in patients who received 0.2 or 0.3 mg/kg diltiazem 60 seconds before the start of laryngoscopy. These data were compared with a control group who received saline. ⋯ These increases after tracheal intubation were reduced in diltiazem-treated patients compared with those of the control group (p less than 0.05). The data suggest that a bolus injection of diltiazem is a simple, practical and effective method to attenuate the hypertensive response to laryngoscopy and tracheal intubation.