Anaesthesia
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We observed the sensory, motor and cardiovascular changes occurring during subarachnoid infusion of bupivacaine 0.125% at 15 ml.h-1 in six patients. After 1 h, motor block and lower sensory levels were consistent and predictable but upper sensory levels were variable. There was a moderate decrease in systolic blood pressure. Regular assessments of motor block are more likely to detect accidental subarachnoid infusion than assessments of upper sensory level or measurements of blood pressure.
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A case of phrenic nerve paralysis following interpleural analgesia for cholecystectomy is reported. The pre-operative chest X ray was normal but chest X ray after cholecystectomy and interpleural analgesia revealed a raised right hemidiaphragm. This resolved after discontinuation of the interpleural analgesia and was probably a result of phrenic nerve paralysis produced by the interpleural local anaesthetic.
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Attitudes of anaesthetists of various grades working in different types of hospital in England and Wales, to parental presence in the anaesthetic room during induction of anaesthesia in children were assessed by means of a postal questionnaire. Of the 300 questionnaires sent out, 244 (82%) were completed. ⋯ A small but significant number expressed reservations about some aspects of parental presence. The grade of anaesthetist and type of hospital did not appear to influence the response.
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Randomized Controlled Trial Clinical Trial
Dose-response for analgesic effect of amitriptyline in chronic pain.
A randomised, double-blind, multiple dose, crossover study with three 3-week treatment periods was set up to compare the analgesic efficacy and adverse effects of amitriptyline in oral doses of 25, 50 or 75 mg. Patients used diaries to assess their pain, and clinic assessments were made at the end of each treatment period. ⋯ The incidence of adverse effects was significantly higher with the 75 mg dose, and the principal adverse effects were dry mouth and drowsiness. In the context of chronic pain, the analgesic effect of amitriptyline was shown to have a dose-response unrelated to mood elevation, but there was a dose-response for the incidence of adverse effects.
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Randomized Controlled Trial Comparative Study Clinical Trial
The level of neuromuscular block needed to suppress diaphragmatic movement during tracheal suction in patients with raised intracranial pressure: a study with vecuronium and atracurium.
The effects of tracheobronchial suction before and after neuromuscular blockade with vecuronium (0.12 mg.kg-1; ED95 x 2; group A) and atracurium (0.4 mg.kg-1; ED95 x 2; group B) on intracranial pressure were studied in 18 neurosurgical patients with a Glasgow Coma Scale < 7. Despite adequate sedation, moderate to severe diaphragmatic movements (bucking and coughing) in response to carinal stimulation with significant increases in intracranial pressure (A: 18 SD 7 to 24 SD 8 mmHg; B: 19 SD 7 to 27 SD 5 mmHg) and subsequent decreases in cerebral perfusion pressure (group A: 69 SD 11 to 63 SD 8 mmHg; group B: 63 SD 11 to 59 SD 17 mmHg) could be observed without muscle relaxation. ⋯ Slight diaphragmatic movements could be elicited in only two patients in group A and in two patients in group B during tracheal suction; intracranial pressure (group A: 20 SD 8 to 20 SD 8 mmHg; group B: 19 SD 7 to 19 SD 7 mmHg) and cerebral perfusion pressure (group A: 65 SD 13 to 65 SD 13 mmHg; group B: 66 SD 12 to 65 SD 11 mmHg) remained unchanged. When coordinating respiratory therapy in neurosurgical intensive care patients, profound neuromuscular block, quantified by a post-tetanic count of at least 5 for vecuronium and 1 for atracurium, it is necessary to rule out any impact of diaphragmatic movement on intracranial pressure.(ABSTRACT TRUNCATED AT 250 WORDS)