Anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Diclofenac sodium for post-tonsillectomy pain in children.
Diclofenac sodium was assessed as an analgesic for postoperative pain following paediatric tonsillectomy in a randomised double blind trial. In a comparison made with both a pethidine and a control group diclofenac was shown to be an effective analgesic. No significant difference in analgesic efficacy was demonstrated between the two drugs, although patients who received diclofenac tended to be less drowsy postoperatively than those who received pethidine. There were no significant differences between the two drugs in respect of time to awaken from anaesthesia or incidence of postoperative vomiting.
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Randomized Controlled Trial Comparative Study Clinical Trial
Heart rate and arterial pressure changes during fibreoptic tracheal intubation under general anaesthesia.
The cardiovascular responses to fibreoptic orotracheal intubation under general anaesthesia were compared with those in a control group in whom tracheal intubation was effected with a Macintosh laryngoscope. The patients received a standard anaesthetic and were allocated randomly to either group immediately before intubation. Fibreoptic intubation took significantly longer to perform. ⋯ The tachycardia in the fibreoptic group was significantly greater than that in the control group during the second minute after intubation, and the increase in systolic pressure was sustained for a longer period in the fibreoptic group. The maximum increases in systolic and diastolic pressures above pre-intubation values were significantly greater in the fibreoptic group. The cardiovascular responses associated with fibreoptic intubation under general anaesthesia appear to be more severe than those which follow intubation effected with a Macintosh laryngoscope.
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Plasma bupivacaine concentrations were measured in 27 children aged 3-7 years who received one of two analgesic regimens for herniotomy or orchidopexy. Analgesia was provided either by caudal epidural bupivacaine 0.2% 2 mg/kg (n = 14) or by ilioinguinal-iliohypogastric nerve block with bupivacaine 0.5% 1.25 mg/kg (n = 13). ⋯ Time to peak plasma concentrations were 29.6 (7.9) and 22.3 (10.9) minutes respectively. These concentrations are well below the potentially toxic level of 4.0 micrograms/ml, but suggest that uptake of bupivacaine is more rapid after ilioinguinal-iliohypogastric nerve block than during caudal analgesia.
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A case is described of an extensive block and hypotension which occurred after inadvertent dural puncture and subsequent epidural injection of bupivacaine. The subarachnoid spread of solution from the extradural space was confirmed radiologically.
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This survey reviews the structure and content of all anaesthetic record charts in use in the 40 hospitals of the Yorkshire Regional Health Authority in the light of previous recommendations. Twenty-two different anaesthetic charts were used by 290 anaesthetists in this region. ⋯ Fourteen of the 22 charts omitted important headings concerned with patient identification and eight charts did not provide a record of the whole perioperative period. Some comprehensive forms are in use, chiefly in smaller hospitals, but there have been few changes in design in the last 10 years despite increasing medicolegal awareness.