Anaesthesia
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A study using postmortem dura mater demonstrated that rotation of the epidural needle significantly decreases the force required to puncture the dura. It is recommended that epidural needles should not be rotated after insertion of the tip into the epidural space.
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This case study emphasises the multiple factors that may be involved in the precipitation of electromechanical dissociation, which are compounded by additional problems that relate to pregnancy. It reinforces the value of the tracheal route for drug administration when a central vein is not cannulated and stresses the importance of posture and early consideration of Caesarean section in the pre-term gravid patient who has sustained a cardiac arrest.
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Randomized Controlled Trial Comparative Study Clinical Trial
Analgesia from morphine and ketamine. A comparison of infusions of morphine and ketamine for postoperative analgesia.
Ketamine 4 micrograms/kg/minute produced pain relief similar to that from morphine 33 micrograms/minute in a double-blind study that compared analgesia from constant-rate intravenous infusions of the two drugs in 60 patients. The analgesic efficacy of the infusions, as assessed by pain scores and the requirement for supplementary self-administered morphine, was poor. Ventilatory depression, the most significant side effect, occurred only in patients who received morphine infusion. The low dose ketamine infusion did not provide clinically useful analgesia even though adequate plasma concentrations were achieved.
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Two hundred and forty-two routine surgical patients who had undergone general anaesthesia, were questioned about postoperative sore throat by one of two methods, either direct or indirect questioning. A significantly higher incidence of sore throat was obtained by direct questioning (p less than 0.001).