Anaesthesia
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Randomized Controlled Trial Clinical Trial
Enhancement of pressor response to ephedrine following clonidine medication.
We studied pressor responses and changes in plasma catecholamine concentrations following two consecutive doses of ephedrine 0.1 mg.kg-1 with (n = 20) and without (n = 20) clonidine 5 micrograms.kg-1 premedication in patients presenting for a variety of major surgical procedures under general anaesthesia. Arterial blood pressure and heart rate were measured at 1 min intervals for 10 min, and plasma catecholamines were measured before and 3 min after each dose of ephedrine. ⋯ Plasma catecholamine concentrations tended to be lower in the clonidine group throughout the study. The augmented pressor response to ephedrine in clonidine-treated patients can be attributed to enhanced cardiovascular response rather than clonidine-induced accumulation and subsequent increased release of catecholamine.
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Clinical Trial Controlled Clinical Trial
Effects of topical benzocaine and lignocaine on upper airway reflex sensitivity.
We studied the degree and duration of effect on upper airway reflex sensitivity of oral benzocaine lozenges, nebulised lignocaine and lignocaine sprayed onto the vocal cords under direct vision, using low concentrations of ammonia as a stimulus to upper airway receptors. Ten minutes after the administration of oral benzocaine 20 mg the threshold response of the upper airway to ammonia (NH3TR) had risen significantly from baseline mean (SEM) of 680 (95) to 975 (109) ppm of ammonia with a return to baseline values after 25 min (n = 8, p < 0.05, repeated measures of ANOVA; p < 0.001, t-test). ⋯ The application of 4% nebulised lignocaine 4 ml significantly increased NH3TR from a baseline mean (SEM) of 770 (56) to a maximum of 1190 (63) ppm of ammonia with a significant elevation in the threshold persisting for 30 min (n = 8, p < 0.001, repeated measures of ANOVA; p < 0.05, t-test). The maximum elevations in NH3TR with the two methods of lignocaine delivery were significantly different (p < 0.01, 2-way ANOVA).
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Case Reports
Transient radicular irritation after single subarachnoid injection of isobaric 2% lignocaine for spinal anaesthesia.
Several cases have been reported recently in which symptoms suggestive of transient radicular irritation occurred following the use of hyperbaric 5% lignocaine for spinal anaesthesia. We report on three patients in whom we observed similar symptoms attributable to this kind of radicular irritation following uneventful spinal anaesthesia using isobaric 2% lignocaine. All three patients underwent minor gynaecological procedures and developed burning pains in the buttocks within 24 h of surgery. The long-term outcome was not clear for all the patients, but in at least one the pain disappeared.
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In the early 1940s, Dr M. H. ⋯ The apparatus was essentially a combination of Water's to-and-fro soda-lime canister and Hewitt's ether inhaler. The description of the apparatus is followed by a brief historical note on Dr Armstrong-Davison.
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Case Reports
Respiratory arrest in a parturient following intrathecal injection of sufentanil and bupivacaine.
A 19-year-old obstetric patient had a respiratory arrest shortly after receiving intrathecal sufentanil and bupivacaine as part of a combined epidural/spinal technique for pain relief in labour.