Anaesthesia
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Letter Case Reports
Failed epidural in an obese patient--blame it on Pythagoras!
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Randomized Controlled Trial Clinical Trial
Minimum local analgesic dose of plain ropivacaine vs. ropivacaine combined with sufentanil during epidural analgesia for labour.
We have used the up-and-down allocation technique to assess the relative analgesic potencies of epidural ropivacaine alone and ropivacaine combined with sufentanil 0.75 microg.ml-1 in 42 women requesting epidural analgesia in the first stage of labour. Parturients were randomly allocated to one of the two epidural solutions in a double-blind manner. The concentration of local anaesthetic was determined by the response of the previous parturient: an effective concentration (pain < or = 10 mm on a 10-cm visual analogue pain score within 30 min) resulted in a 0.01% decrease in the concentration of ropivacaine for the next parturient, an ineffective concentration resulted in a 0.01% increase. Minimum local analgesic concentration of ropivacaine alone was 0.13% (95% CI 0.12-0.13%) compared with 0.09% (95% CI 0.08-0.1%) for ropivacaine with sufentanil (p < 0.00001).
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The arterial tourniquet is widely used in upper and lower extremity surgery and in intravenous regional anaesthesia. The local and systemic physiological effects and the anaesthetic implications are reviewed. ⋯ Systemic effects are related to the inflation or deflation of the tourniquet. Safe working guidelines for the application of an arterial tourniquet have not been clearly defined.