Anaesthesia
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Clinical Trial
Magnesium sulphate for control of spasms in severe tetanus. Can we avoid sedation and artificial ventilation?
A prospective pilot study was undertaken to investigate the ability of magnesium sulphate to control the spasms of severe tetanus without the need for sedation and artificial ventilation. All eight patients admitted with severe tetanus to our intensive care unit within the last year were given magnesium sulphate intravenously as a 5-g loading dose followed by an infusion of 2-3 gh-1. The infusion rate was increased to control spasms while retaining the patella tendon reflex, which proved a valid guide to avoid overdose. ⋯ There was no evidence of cardiovascular instability due to sympathetic over activity. No supplementary sedation was required for the control of spasms or autonomic dysfunction during magnesium therapy. We conclude that magnesium sulphate can be used as the sole agent for the control of spasms in tetanus without the need for sedation and artificial ventilation.
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Multicenter Study
Behavioural changes in children following day-case surgery: a 4-week follow-up of 551 children.
The purpose of this prospective multicentre survey was to evaluate the occurrence and the type of changes in children's behaviour during the first 4 weeks following the day of surgery, and to assess the significance of some patient-related factors on the incidence. Pre- and postoperative questionnaires were completed by the parents of 551 children aged 4 months to 13.4 years in five hospitals incorporating nine operative units in Northern Finland. The overall incidence of problematical behavioural changes was 47% and that of beneficial changes 17%. ⋯ Pain on the day of the operation predicted the occurrence of behavioural problems up to the 4th week, 2-4 weeks longer than the duration of pain itself. The results emphasise the importance of effective prevention of postoperative pain as well as the importance of avoiding unpleasant experiences in all contacts children have with health care. Playing could perhaps be used to help children cope with a short hospital experience.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
A comparative multicentre trial of spinal needles for caesarean section.
We studied 681 patients in a randomised, multicentre, double-blind, parallel group trial designed to assess the incidence of headache following spinal anaesthesia for Caesarean section using four different pencil point spinal needles. The needles used were: Whitacre 25G (n = 170), Polymedic 25G (n = 170), Sprotte 24G (n = 173) and Polymedic 24G (n = 168). ⋯ There was no statistically significant difference between the four groups for PDPH. We conclude that all four needles studied performed satisfactorily and comparably.
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Randomized Controlled Trial Clinical Trial
The influence of age upon opioid analgesic use in the patient-controlled analgesia (PCA) environment.
It is often asserted that older patients are more sensitive to opioid analgesics than younger patients but experimental evidence for this assertion remains sparse. Two studies were conducted investigating the relationship between age and opioid analgesic use in the patient-controlled analgesia environment. In study I, the relationship was analysed subsequent to our publication of a study investigating patients' responses to opioid use with patient-controlled analgesia. ⋯ There was a difference in morphine use with the younger patients using significantly more morphine than the older patients (< 60 years). Findings were less clear for patients receiving pethidine but there was an inverse correlation between age and pethidine use as well. Overall, the findings of these two studies supported the common clinical belief that older patients require less opioids than younger patients.