Anaesthesia
-
Comparative Study
Serum morphine levels. A comparison between continuous subcutaneous infusion and continuous intravenous infusion in postoperative patients.
A study was undertaken to compare continuous subcutaneous infusions of morphine with continuous intravenous infusions in patients whose lungs were mechanically ventilated for 24 hours postoperatively. Serum morphine levels were measured after the end of surgery and at 6, 12, 18 and 24 hours in nine patients receiving continuous subcutaneous morphine and in four patients receiving continuous intravenous morphine given at the same rate. ⋯ The differences in the serum morphine levels and in the requirements of phenoperidine were not statistically significant. We conclude that a continuous subcutaneous infusion of morphine is a simple and effective means of achieving postoperative analgesia.
-
A prospective study was completed of 30 shocked patients admitted consecutively to an intensive therapy unit; the majority of the patients had shock of septic origin. Measurements were made of whole blood lactate together with mean arterial pressure, hourly urine volume and core: peripheral temperature difference at the start of treatment and 3 and 24 hours later. Serial lactate measurements were better at predicting outcome than single measurements. However, lactate measurements were much less valuable than serial measurements of the simple haemodynamic variables.
-
An inflatable neck tourniquet has been developed for compression of the jugular veins during neurosurgery in the sitting position. Neck compression abolishes the subatmospheric pressure within the neck veins and therefore minimises the risk of air embolism. Compression can be applied throughout the initial part of the operation, a major period of risk during these surgical procedures, and released once full surgical exposure has been achieved. Venous congestion is then released and normal operating conditions are restored.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Forum. A comparison between the midline and paramedian approaches to the extradural space.
A prospective, randomised study was devised to compare the midline and paramedian approaches to the extradural space in women during labour. The two approaches were equally successful with respect to catheter insertion and analgesia and had a similar incidence of complications, although the paramedian approach caused patients more discomfort. Since only 2 ml of 1% lignocaine with adrenaline were infiltrated prior to insertion of the Tuohy needle, a greater volume of the local anaesthetic may reduce the discomfort of using the paramedian approach.