Anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Intrathecal administration of morphine for elective Caesarean section. A comparison between 0.1 mg and 0.2 mg.
This study compared the quality of analgesia and incidence of adverse effects with two doses of intrathecal morphine in patients undergoing elective Caesarean section. Fifty patients were randomly allocated to receive either morphine 0.1 mg or 0.2 mg in addition to a standard intrathecal dose of 2.5 ml bupivacaine 0.5% in 8% dextrose. ⋯ Fewer patients in the 0.1 mg morphine group experienced postoperative nausea and vomiting (7 versus 14, p < 0.05). We conclude that the use of 0.1 mg morphine intrathecally produces comparable analgesia to 0.2 mg after Caesarean section with significantly less nausea and vomiting.
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Randomized Controlled Trial Clinical Trial
Injection pain with propofol. Reduction with aspiration of blood.
A randomised, controlled, single-blind study was performed on 100 patients to investigate a new method of reducing pain on propofol injection. Aspiration of 2 ml of the patient's blood into a syringe of propofol immediately before injection was compared with the addition of lignocaine 20 mg or normal saline 2 ml to the propofol before injection. The addition of blood was significantly more effective in reducing pain on injection than the addition of saline (p < 0.001), but was not significantly more effective than the addition of lignocaine.
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Comparative Study Clinical Trial Controlled Clinical Trial
Laryngoscopy using the McCoy laryngoscope after application of a cervical collar.
A rigid cervical collar was applied to 102 patients under general anaesthesia. Laryngoscopy was performed using a McCoy laryngoscope blade (size 3) initially in the standard Macintosh configuration followed by activation of the distal hinged tip. The two views obtained at laryngoscopy were graded according to standard guidelines. ⋯ Difficult laryngoscopy (grade 3 or 4) was encountered in 26/102 patients using the McCoy laryngoscope in the unactivated position (Macintosh configuration). Of these 26 patients, 24 (92.3%) had glottic structures identified (grade 1 or 2) when the distal tip of the laryngoscope blade was activated (p < 0.001). The McCoy laryngoscope significantly improves the view at laryngoscopy in the patient whose neck is immobilised in a rigid cervical collar.
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Comparative Study
The effect of four different surgical prone positions on cardiovascular parameters in healthy volunteers.
Twenty healthy volunteers were placed in four different surgical prone positions: on pillows, on an evacuatable mattress, on pelvic props and in the knee-chest position. The normal supine position was used as a control for the measurement of cardiovascular parameters. Mean arterial pressure was measured by automated oscillotonometry. ⋯ Cardiac index and total vascular resistance index were derived from these data. No significant changes in heart rate or mean arterial pressure occurred when the volunteers were moved from the supine position to any of the four prone positions or when returned to the supine position again. Cardiac index decreased significantly on going from the supine to the knee-chest position (20%) and onto the props (17%) but not onto the evacuatable mattress (11%) or the pillows (3%).
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A 42-year-old woman, undergoing a diagnostic laparoscopy, developed a unilateral lingual nerve palsy following the use of a laryngeal mask airway.