Anaesthesia
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Randomized Controlled Trial Clinical Trial
The effect of prophylactic fentanyl on shivering in elective caesarean section under epidural analgesia.
The aims of this randomised double-blind study were to investigate whether 25 micrograms of fentanyl administered prophylactically by the epidural route would influence the incidence of shivering in parturients who underwent elective Caesarean section under epidural analgesia and whether it would affect the axillary and calf temperatures. There was a 50% reduction (p less than 0.05) in the overall incidence of shivering in patients who received fentanyl and there was some evidence to suggest that low-dose epidural fentanyl might reduce shivering by an influence on thermoregulation.
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Case Reports
Caesarean section in undiagnosed Eisenmenger's syndrome. Report of a patient with a fatal outcome.
An obstetric patient is described in whom the first sign of cardiac disease was unexplained hypoxaemia during emergency anaesthesia for antepartum haemorrhage, with an eventual fatal outcome. The case highlights the importance of patient information at the booking clinic, and the implications of a raised haemaglobin in early pregnancy.
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Comparative Study
Cardiovascular effects of epidural local anaesthetics. Comparison of 0.75% bupivacaine and 0.75% ropivacaine, both with adrenaline.
The cardiovascular effects of 20 ml 0.75% bupivacaine with adrenaline 5 micrograms/ml injected epidurally were compared with those of 20 ml 0.75% ropivacaine with adrenaline. Cardiovascular measurements were performed with a transthoracic electrical bioimpedance monitor. The maximum mean arterial blood pressure decreased significantly from baseline values after both solutions, but the decrease after 20 minutes was more pronounced with bupivacaine (21%) than with ropivacaine (9.6%). ⋯ The mean of the maximum increase of the ejection fraction was 13% in the bupivacaine group and 9% in the ropivacaine group, but was only significantly different from baseline values following bupivacaine. There was no difference in the onset time or height of the sensory block between the groups. The cardiovascular changes can be ascribed to sympathetic blockade and to systemic absorption of the local anaesthetics and adrenaline.
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Randomized Controlled Trial Clinical Trial
Wound infiltration of local anaesthetic after lower segment caesarean section.
The analgesic efficacy of subcutaneous wound infiltration with 20 ml of 0.5% bupivacaine after elective lower segment section Caesarean section was studied in 28 patients in a double-blind randomised controlled manner using a patient-controlled analgesia system. The mean 24-hour morphine consumption of the placebo group and the bupivacaine group was similar (76 mg and 68 mg respectively). ⋯ However, on a weight-adjusted basis statistically significant differences in morphine consumption were demonstrated, although these may not be clinically important. Subjective experiences of pain, nausea and drowsiness assessed by linear analogue scoring were similar in both groups.
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Randomized Controlled Trial Comparative Study Clinical Trial
Single operator cardiopulmonary resuscitation in ambulances. Which ventilation device?
Cardiopulmonary resuscitation en route to hospital is performed by a single-handed operator in many British ambulances. In this study, three emergency ventilation devices, and mouth-to-mouth breathing, were compared for effectiveness in unintubated patients. ⋯ There were significant differences in minute volume (p less than 0.01) and number of effective chest compressions (p less than 0.05); mouth-to-mouth breathing produced the best overall results and the simplest device was a close second. The value of automatic ventilators for single-operator cardiopulmonary resuscitation in unintubated patients is questioned.