Anaesthesia
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The evoked motor responses to magnetic and electrical peripheral nerve stimuli were quantitatively assessed after vecuronium in 15 women undergoing gynaecological surgery. Anaesthesia was induced with thiopentone and fentanyl and maintained with intermittent doses of fentanyl and 66% nitrous oxide in oxygen. After immobilisation of both forearms in splints, the ulnar nerves were stimulated supramaximally every 10 s with a magnetic stimulator (Magstim Model 200) and an electric stimulator (Myotest) on opposite sides. ⋯ The difference in the evoked responses between the two types of stimulation was approximately 20% overall and was significant 2 min after vecuronium administration (p < 0.05). The rate of recovery of the evoked twitch responses was more rapid with magnetic than electric stimulation. It is concluded that magnetic stimulation of peripheral nerve is a useful technique for evaluating residual neuromuscular blockade.
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Randomized Controlled Trial Clinical Trial
Oral administration of midazolam as a premedicant for paediatric day-case anaesthesia.
Fifty-four children aged 1-10 years, scheduled for day-case anaesthesia were prescribed either oral midazolam 0.5 mg.kg-1 or a placebo preparation 30-60 min pre-operatively on a double-blind basis. On arrival at the induction room, anxiolysis was satisfactory in 23 out of 24 (96%) children who received midazolam compared with 12 out of 27 (44%) of those who received placebo (p < 0.001); at induction of anaesthesia these proportions were 21 out of 24 (88%) and nine out of 27 (33%) respectively (p < 0.001). ⋯ Similarly, the time to hospital discharge was longer in the midazolam group (244 vs 185 min) (p < 0.01). Analysis of behavioural questionnaires completed by parents 2 weeks after hospitalisation indicated that there were fewer postoperative behavioural disturbances in children premedicated with midazolam compared with controls (p < 0.05).
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Randomized Controlled Trial Clinical Trial
A simple method for the maintenance of oxygen saturation following intravenous induction of anaesthesia with propofol.
One hundred unpremedicated fit adult patients having elective minor day-stay surgery and general anaesthesia were randomly allocated to one of two groups. During 30 s of intravenous propofol administration (2.5 mg.kg-1), study group patients (n = 50) were instructed to take three vital capacity breaths of room air, whilst control group patients (n = 50) were given no specific instructions. Pulse oximetry was continuously recorded over the next 5 min and the lowest oxygen saturation was noted. ⋯ Oxygen saturation returned to the pre-induction value significantly earlier in the study group patients compared with controls (97 s vs 135 s, p < 0.01). These results demonstrate that significant desaturation occurs in patients following intravenous induction of anaesthesia with propofol. This desaturation may be attenuated by asking patients to take three vital capacity breaths of room air during induction of anaesthesia.
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Randomized Controlled Trial Clinical Trial
The addition of triamcinolone acetonide to bupivacaine has no effect on the quality of analgesia produced by ilioinguinal nerve block.
In a study of 30 men undergoing elective inguinal hernia repair under general anaesthesia no difference in postoperative pain, patient rating score or morphine consumption was found between patients who had pre-operative ilioinguinal nerve block with bupivacaine 0.5% plain and those who received a similar block with bupivacaine 0.5% plain and triamcinolone acetonide 40 mg. Mean (SD) morphine requirements using a patient-controlled analgesia system were 37 (22.2) mg and 32 (20.3) mg in the bupivacaine and bupivacaine/triamcinolone groups respectively (p > 0.05). The addition of triamcinolone 40 mg to bupivacaine 0.5% offers no advantages over unsupplemented bupivacaine when used for ilioinguinal block.
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Three surveys of postoperative patients and surgical ward staff were conducted in an 840-bed university hospital to ascertain the severity of pain after surgery and the reasons why patients in pain do not receive more of the analgesia prescribed for them. In the first survey, 206 inpatients were questioned within 24 h following operation, and 25.2% of patients experienced moderate pain whilst 9.2% experienced severe pain but received only 36% of their prescribed analgesics. ⋯ Twenty-nine percent were moderately or very concerned about injections. The beliefs of both ward staff and patients could have contributed to this failure of pain relief.