Anaesthesia
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Randomized Controlled Trial Clinical Trial
Memory of cardiac anaesthesia. Psychological sequelae in cardiac patients of intra-operative suggestion and operating room conversation.
Thirty patients scheduled for elective cardiopulmonary bypass surgery were interviewed pre-operatively and postoperatively to assess changes in their emotional state and recollections, both aware and unaware, of intra-operative events. A random selection of patients heard a prerecorded audio tape towards the end of bypass after they were rewarmed to 37 degrees C. The tape contained suggestions for patients to touch their chin during the postoperative interview, to remember three sentences and to recover quickly. ⋯ Seven patients (23%) recalled intraoperative events, five with the aid of hypnosis. Three reports (10%) were corroborated. Pre-operative medication (p less than 0.01) and postoperative anxiety (p less than 0.05) were significant predictors of those patients who reported recall.
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Comparative Study
Day-case herniotomy in children. A comparison of ilio-inguinal nerve block and wound infiltration for postoperative analgesia.
Forty-nine boys scheduled for day-case inguinal herniotomy were studied to compare ilio-inguinal nerve block and wound infiltration for postoperative analgesia. Both techniques were simple to perform and produced no complications. ⋯ Some children did appear to have pain following discharge but in all cases this responded well to simple analgesics. We conclude that both techniques provide satisfactory analgesia whilst the complications of narcotics are avoided, and suggest that simple infiltration of the wound with local anaesthetic solution should be encouraged in paediatric anaesthesia.
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Case Reports
Cardiovascular collapse following epidural anaesthesia for Caesarean section in a patient with aortic incompetence.
A death following epidural anaesthesia for Caesarean section in a patient with aortic incompetence and pre-eclampsia is described. Possible hazards of epidural anaesthesia in aortic incompetence are described and it is suggested that reduction of total peripheral resistance is contraindicated in such patients.
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Surgical procedures that involve a local anaesthetic block are often accompanied by light general anaesthesia. It is possible that under these circumstances, the patients are more likely to register auditory events while apparently unconscious. Two groups of children were exposed to auditory stimuli during surgery; one group received a lighter level of anaesthesia than the other. ⋯ The light anaesthesia group retained more items than did the other two groups but this difference was significant (p less than 0.05) only when compared with the other experimental group. This is not very strong evidence of auditory registration, but a greater effect might be found with exposure to emotionally significant material. It is suggested that patients should be protected from unfortunate theatre conversation.
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Comparative Study
Pregnanolone emulsion. A new steroid preparation for intravenous anaesthesia: an experimental study in mice.
The anaesthetic activity of pregnanolone (a metabolite of progesterone) in emulsion formulation administered intravenously to male mice was compared with that of Althesin. The loss of righting reflex for 15 seconds was used to estimate the anaesthetic effect. The mean anaesthetic dose (AD50) for the pregnanolone emulsion was 5.25 mg/kg and for Althesin, 2.8 mg/kg. ⋯ The onset of action was fast for both drugs, with only minor signs of excitation, and recovery was rapid and without excitation. The results indicate that the anaesthetic properties of pregnanolone emulsion are very similar to those of Althesin. Further studies will show whether it can fill the major vacuum left in anaesthetic practice after the withdrawal of Althesin.