Anaesthesia
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Dr Nathan Cooley Keep (1800-1875) was a Boston dentist and doctor who carried our pioneering work in both dentistry and anaesthesia. He worked with William Morton before the first public demonstration of ether anaesthesia, formed the world's first anaesthetic partnership with Morton but parted company with him and later opposed Morton's claim to be the sole inventor of ether anaesthesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
The effects of pethidine, fentanyl and lignocaine on postanaesthetic shivering.
Pethidine is reported to be more effective than equi-analgesic doses of other opioids as an inhibitor of postanaesthetic shivering. The aim of this study was to verify whether this action resulted from a local anaesthetic effect of pethidine or from inadequate fentanyl dosage in previous studies. We studied 52 ASA 1 or 2 patients. ⋯ The mean (SD) core temperature in the pethidine group was slightly lower than that in the fentanyl group (35.1 (0.6) and 35.9 (0.5)) when the patients stopped shivering. Furthermore, shivering restarted in 6/10 patients in the fentanyl group after 15 min compared with 1/12 in the pethidine group. Our results show that fentanyl (1.7 micrograms.kg-1) can inhibit postanaesthetic shivering but this effect is less pronounced and of shorter duration than with pethidine (0.85 mg.kg-1).
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Randomized Controlled Trial Clinical Trial
Lignocaine test dose to detect intravenous injection.
The accidental intravascular injection of bupivacaine or etidocaine epidurally has resulted in several maternal deaths. To be effective, a test dose must allow detection of intravenous catheter placement and prevent accidental intravenous injection. This study was designed to determine the dose of lignocaine required for this purpose. ⋯ At 1 min intervals the patients were asked about subjective symptoms produced by this 'test dose'. In group 2 only 50% of patients reported a positive test dose, whereas in the patients of group 3, a significantly greater percentage (95%) had a positive test dose (p < 0.01). This suggests that the use of 1 mg.kg-1 lignocaine as a test dose would result in a significantly higher sensitivity for detecting intravascular injection than the use of 0.5 mg.kg-1.
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Randomized Controlled Trial Clinical Trial
Sedation with intravenous infusions of propofol or thiopentone. Effects on pain perception.
The aim of this study was to investigate pain perception during thiopentone or propofol infusions for sedation. Thirty ASA 1 or 2 patients received a two step infusion of either thiopentone (step 1: 1.25 mg.kg-1 followed by 2.5 mg.kg-1.h-1; step 2: 1.25 mg.kg-1 and 12.5 mg.kg-1.h-1; n = 15) or propofol (step 1: 0.5 mg.kg-1, 1 mg.kg-1.h-1; step 2: 0.5 mg.kg-1, 5 mg.kg-1.h-1; n = 15) for sedation. At control and 10 min after the start of each infusion dosage, reaction times and thermal pain detection thresholds were determined. We found no clinically or statistically significant depression of thermal pain detection thresholds during propofol or thiopentone infusions and these are, therefore, unlikely to be associated with clinically relevant hyperalgesia.
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Randomized Controlled Trial Clinical Trial
Forced-air warming maintains normothermia during orthotopic liver transplantation.
We evaluated the efficacy of forced-air warming to maintain normothermia during liver transplantation. In a prospective, clinical trial 20 patients were randomly assigned to routine thermal management (circulating-water mattress set at 42 degrees C, intravenous fluid warming to 37 degrees C and passive insulation) or routine management with additional forced-air warming of head, chest, and arms. Core temperature was measured in the pulmonary artery. ⋯ Despite the relatively high ambient temperature, patients warmed only with a circulating-water mattress and passive insulation became hypothermic during surgery. In contrast, when forced-air warming was added to this routine thermal management, patients were normothermic at the end of surgery. Forced-air warming prevented intra-operative hypothermia during liver transplantation.