Anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of midazolam with trimeprazine as an oral premedicant for children.
The effect of oral premedication was investigated in a double-blind, randomised trial in 85 children undergoing tonsillectomy and/or adenoidectomy. Orally administered midazolam 0.5 mg.kg-1 given 30 min pre-operatively was compared with trimeprazine 2 mg.kg-1 given 90 min pre-operatively and a placebo preparation. Compliance, sedation and ease of induction were assessed as were the duration and quality of recovery. ⋯ More patients were calm and quiet on arrival in the anaesthetic room following midazolam than following trimeprazine, with both premedicant agents comparing favourably with placebo. There was no significant difference between the three groups in the time to recovery or the sedation score on discharge to the ward. Midazolam is a safe and effective oral premedicant for children.
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Awareness remains a serious complication of general anaesthesia with potential adverse psychological sequelae. Even during seemingly adequate general anaesthesia, implicit memory may be retained along with the ability to subconsciously process auditory stimuli. ⋯ We shall discuss the structure of memory and the effects of increasing doses of general anaesthesia on cognitive processes. In addition methods of assessing the depth of anaesthesia will be reviewed.
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Clinical Trial
Evaluation of thoracic epidural catheter position and migration using radio-opaque catheters.
Migration of thoracic epidural radio-opaque catheters was evaluated in 25 patients scheduled for thoracic surgery in the supine position (n = 5) or in the lateral position with lateral extension of the thoracic spine (n = 20). Chest radiography was performed daily for 3 days after operation. ⋯ The catheter tip position was unchanged in all patients operated upon in the supine position. In the group operated upon in the lateral position, the catheter tip retracted from day 1 to day 2 by an average of 0.69 cm (SD 1.08; p < 0.05); from day 2 to day 3 the average retraction was 0.35 cm (SD 0.67; p < 0.05).
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In order to evaluate the general public's knowledge of postoperative pain and its management, a simple questionnaire was devised and sent out to five general practices in Scotland and Yorkshire. Questionnaires were completed voluntarily by 529 people attending their general practitioner for reasons not related to surgery. Five hundred and fifteen completed questionnaires were analysed. ⋯ Attitudes to pain varied greatly and confirm the findings of other surveys that amongst the general public there is little or no understanding of the nature of postoperative pain or of the methods available to treat it. Despite the published literature, the public have a high degree of confidence in the ability of doctors and nurses to treat such pain. Widespread public and professional education is required before further improvements can be made to such a universal and basic clinical problem.