Anaesthesia
-
Randomized Controlled Trial Clinical Trial
Intrathecal diamorphine for analgesia after caesarean section. A dose finding study and assessment of side-effects.
Eighty women undergoing elective Caesarean section under spinal anaesthesia using hyperbaric bupivacaine 0.5% were randomly allocated to receive, in addition, intrathecal diamorphine 0.125, 0.25 or 0.375 mg or saline. Postoperative morphine requirements, measured using a patient-controlled analgesia system, were reduced in a dose-dependent manner by diamorphine. Pain scores were significantly lower at 2 and 6 h following the two larger doses of diamorphine. ⋯ There were no adverse neonatal effects. Intrathecal diamorphine in the present study was found to be safe in doses of up to 0.375 mg following Caesarean section. However, minor side-effects were frequently observed.
-
Randomized Controlled Trial Clinical Trial
Requirements for target-controlled infusion of propofol to insert the laryngeal mask airway.
The success rate for insertion of the laryngeal mask airway was assessed in 60 patients using a target-controlled infusion of propofol. Eleven of 15 patients who received a target propofol concentration of 5 micrograms.ml-1 had the laryngeal mask inserted successfully within 3 min of induction of anaesthesia. Fourteen of 15 patients who received 6 micrograms.ml-1 had successful insertion within 3 min and all 15 patients who received 7 micrograms.ml-1 had successful insertion within 3 min. ⋯ The increased success rate of LMA insertion with the higher target propofol concentrations was achieved without major haemodynamic effects in this group of fit patients. However, adverse cardiovascular effects may occur with these doses in elderly or unfit patients. It is important in individual patients to titrate the target propofol concentration to achieve the required clinical endpoint.
-
We report a case of Streptococcus salivarius meningitis following combined spinal-epidural analgesia for labour. Although rare, bacterial meningitis following combined spinal-epidural anaesthesia is being increasingly described. We review the previously reported cases and discuss the possible aetiological causes and the aseptic precautions likely to reduce the incidence of infectious complications.
-
Two hundred patients completed a questionnaire about their experiences of patient-controlled analgesia. The questionnaire covered the following topics: pre-operative information, reasons for pressing and not pressing the button, pain relief, side-effects, safety, advantages and disadvantages of patient-controlled analgesia, worries associated with its use and control over pain. ⋯ However, more detailed questions revealed side-effects and fears that constrained its use and hence patients' ability to control pain. Control is predominantly a feature of the professional's view of patient-controlled analgesia, rather than the patient's experience of this analgesic technique.
-
Five hundred members of the Obstetric Anaesthetists Association were surveyed regarding their technique for identification of the epidural space. Eighty-one per cent of the questionnaires were returned completed. Fifty-nine per cent of respondents first learned a loss of resistance to air technique, 33.4% to saline and 7.4% another technique. ⋯ Twenty-eight per cent taught a loss of resistance to air, 57.2% taught a loss of resistance to saline and 12.9% taught both techniques. Twenty-three per cent changed from a loss of resistance to air, to a saline technique, and 4.2% vice versa. Forty-seven per cent of those using air felt that loss of resistance to air was not associated with a clinically significant difference in the incidence of accidental dural puncture compared with saline.