Anaesthesia
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Randomized Controlled Trial Clinical Trial
Pain following thoracotomy. A randomised, double-blind comparison of lumbar versus thoracic epidural fentanyl.
Fifty-eight patients scheduled for elective thoracotomy were randomly allocated to receive fentanyl by either the thoracic or the lumbar epidural route for postoperative analgesia. The infusion rate was adjusted to optimise analgesia. ⋯ In addition, there was no significant difference in dose requirements or incidence of side effects between the two groups. There appears little justification for the use of the generally less familiar, and potentially more dangerous, thoracic approach when fentanyl alone is infused into the epidural space following thoracotomy.
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Randomized Controlled Trial Clinical Trial
Diamorphine analgesia after caesarean section. Comparison of intramuscular and epidural administration of four dose regimens.
In a randomised double-blind study, the efficacy, duration of action and side effects of five diamorphine analgesia regimens following Caesarean section are described. The time to next analgesia was shorter in the 5 mg intramuscular group (3.53 hours) than in any of the four epidural groups: 5 mg (5.7 hours, p = 0.007), 2.5 mg (4.76 hours, p = 0.103), 5 mg with adrenaline 1/200,000 (7.2 hours, p = 0.001) and 2.5 mg with adrenaline 1/200,000 (6.05 hours, p = 0.007). ⋯ The 5 mg dose with adrenaline showed no advantage when compared with 2.5 mg with adrenaline (p = 0.16). No serious side effects were reported in any group.
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Intra-ocular pressure was measured before and throughout airway establishment with either the laryngeal mask airway or tracheal tube. Similar measurements were made on removal of either airway and the amount of coughing noted in the first minute after removal. ⋯ There was a significantly greater rise in heart rate using the tracheal tube (p less than 0.01) probably related to an increased cardiovascular response. The laryngeal mask airway is recommended as an alternative to tracheal intubation in routine and emergency intra-ocular surgery.
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An acute episode of a malignant hyperthermia-like syndrome is described which occurred after suxamethonium and isoflurane anaesthesia in a 41-year-old healthy male patient undergoing a minor elective hand operation. Dantrolene therapy rapidly reversed the life-threatening signs. Laboratory results appeared to confirm the suspicion of malignant hyperthermia. However, the in vitro contracture test, which was carried out according to the standards of the European Malignant Hyperthermia Group, was equivocal.
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Randomized Controlled Trial Comparative Study Clinical Trial
Analgesic efficacy of controlled-release dihydrocodeine. A comparison of 60, 90 and 120 mg tablets in cold-induced pain.
A prospective, double-blind, single-dose placebo-controlled four-part crossover study of 12 healthy volunteers was carried out to compare the analgesic efficacy of controlled-release dihydrocodeine tablets 60, 90 and 120 mg (DHC Continus tablets, Napp Laboratories) in cold-induced pain. Subjects received each of the four treatments in a random order using a latin square design. On each of the four study days, the volunteers performed cold pressor tests, before dose and again at 4, 8 and 12 hours after dose. ⋯ At 4 hours there was a significant reduction in pain in subjects who received 120 mg or 90 mg tablets compared with placebo, and in subjects who received 120 mg tablets compared with those who received 60 mg tablets. At 8 hours, 120 mg and 90 mg dihydrocodeine were still better than placebo. There was no significant difference in side effects between treatments.