Anaesthesia
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Randomized Controlled Trial Comparative Study
Epidural lidocaine-bicarbonate-adrenaline vs levobupivacaine for emergency Caesarean section: a randomised controlled trial.
Epidural mixtures containing lidocaine with or without additives are commonly used to convert epidural analgesia in labour to anaesthesia for emergency Caesarean section, but direct comparisons with alternative, single agents in this situation are few. In a prospective double-blinded trial, we compared a freshly prepared lidocaine-bicarbonate-adrenaline mixture (final concentrations 1.8%, 0.76% and 1:200,000, respectively) with our standard agent, levobupivacaine 0.5%, for extending epidural blockade for emergency Caesarean section. Using a sequential analysis technique, with data analysed in blocks of 40, women receiving epidural analgesia in labour who required top-up for Caesarean section were randomly assigned to receive 20 ml of epidural solution over 3 min. ⋯ Pre- and intra-operative supplementation/pain, maternal side-effects and neonatal outcomes (excluding five women who underwent instrumental delivery) were similar between the groups. Intra-operative maternal sedation (scored by the mother on a 10-point scale) was greater with lidocaine-bicarbonate-adrenaline (4.5 (3-8 [1-9])) than with levobupivacaine (3 (1-4 [1-7])), but not significantly so (p = 0.07). We conclude that epidural lidocaine-bicarbonate-adrenaline halves the onset time when extending epidural analgesia for Caesarean section although there is a possibility of increased maternal sedation.
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Severe septic and cardiogenic shock is associated with a high mortality in neonates, children and adolescents. Common therapies include the administration of fluids and the use of conventional inotropes. However, in severe forms of shock, cardio-circulatory failure may be secondary to profound vasoparalysis and unresponsive to conventional therapies. ⋯ In view of the limited number of paediatric patients treated with AVP/TP, no definite recommendations on their use in children with severe forms of cardio-circulatory failure can be issued. There is a need for larger prospective trials assessing the efficacy and safety profiles of these drugs in a defined setting. Until more data are available, and taking into consideration the detrimental impact catecholamine-refractory shock has on children, the use of AVP/TP as a rescue therapy should be considered on an individual basis.
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Randomized Controlled Trial
Coagulation and biochemical effects of balanced salt-based high molecular weight vs saline-based low molecular weight hydroxyethyl starch solutions during the anhepatic period of liver transplantation.
The anhepatic period of liver transplantation is generally marked by a decrease in preload, and the infusion of hydroxyethyl starch (HES) solution is often an effective way to restore volume deficits in non-anaemic patients. However, the infusion of even limited amounts of HES solution during the anhepatic period may result in a worsening coagulopathy. Moreover, lactate-containing HES solution may cause some degree of biochemical derangements in compromised recipients. ⋯ Less impairment in the thromboelastography profiles and aPTT was observed in the high MW group. A higher calcium concentration and less reduction in platelet count were noted in the high MW group, but lactate accumulation was greater. In conclusion, a balanced salt-based high molecular weight HES solution is a more effective volume replacement during the anhepatic period of liver transplantation with respect to coagulation than a saline-based low molecular weight HES solution, although lactate accumulation is a possible concern.
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Randomized Controlled Trial
The effect of warming local anaesthetic on the pain of injection during sub-Tenon's anaesthesia for cataract surgery.
In a double blind, randomised controlled trial, we examined the effect of warming local anaesthetic solutions on the pain experienced by patients undergoing a sub-Tenon's block for cataract surgery. In all, 140 patients were randomly allocated to receive either local anaesthetic stored at room temperature (control group) or local anaesthetic warmed to 37 degrees C (study group). ⋯ There was no significant difference in pain scores between the two groups. We conclude that the practice of warming local anaesthetic prior to performing a sub-Tenon's block does not significantly reduce the amount of pain experienced by patients.
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The noble gases have always been an enigma. Discovered late in the history of chemistry and in seemingly small quantities in our atmosphere, they are some of the most unreactive elements known. ⋯ Of all of them, the gases that have found the greatest number of uses in the field of anaesthesia and related specialties are helium and xenon. This review focuses on the history of the discovery of both gases, their unique physicochemical properties and describes their uses in clinical practice with particular emphasis on those applicable to anaesthesia.