Anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Nausea and vomiting with use of a patient-controlled analgesia system.
The incidence of nausea and vomiting following patient controlled analgesia and intramuscular morphine injections on demand was compared in a double-blind randomised study of 32 healthy patients undergoing elective cholecystectomy. There were no significant differences between the two groups in mean 24 hour postoperative morphine consumption, subjective experience of pain, nausea and sedation assessed by visual linear analogue scoring, and the postoperative requirements for antiemetic therapy.
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Randomized Controlled Trial Comparative Study Clinical Trial
Epidural bupivacaine dilution for labour. A comparison of three concentrations infused with a fixed dose of fentanyl.
We have compared the effects of three epidural infusions in a randomised, double-blind study of 56 primigravid mothers in labour. An initial dose of bupivacaine 0.5% 8 ml was followed by infusion of either bupivacaine 0.125%, 0.062% or 0.031%. ⋯ Women receiving the most dilute solution had significantly less analgesia (p less than 0.001) for the first 4 hours of the study, but pain scores were then similar for the three groups. No obvious benefit was gained by using very dilute bupivacaine.
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A preliminary study was performed to calculate the cost of intensive therapy on an individual patient basis. The fixed (equipment, supporting services and land opportunity), semi-fixed (staff) and marginal (treatment) costs of 20 critically ill patients were calculated individually. The results show that there is wide variation in intensive therapy costs. ⋯ The mean total cost per patient was 1980 pounds, but the cost per survivor increased by 16% (347 pounds) because of four deaths on the intensive care unit. High total costs are associated with increased severity of illness and higher marginal (treatment) costs are associated with increased semi-fixed (staff) costs. The cost of intensive therapy was three to five times that for general ward care.
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Accidental cannulation of an extradural vein is a troublesome and potentially serious complication of extradural catheter insertion. This study was conducted to assess the influence of posture, catheter size and the injection of saline before catheter insertion, on its occurrence. ⋯ The use of 18-gauge catheters, after injection of 10 ml of 0.9% saline, resulted in a significant (p less than 0.01) reduction in the incidence of extradural vein cannulation. This technique is recommended in obstetric patients as a means of avoiding accidental intravenous injection of local analgesic.