Anaesthesia
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Twenty-one patients scheduled to undergo thoracotomy or median sternotomy had intercostal catheters inserted pre-operatively. During thoracotomy, under direct vision, the spread of 20 ml of a solution containing bupivacaine and methylene blue was followed. ⋯ In three cases, dye was seen crossing the anterior surface of the vertebrae to reach the contralateral aspect. It is concluded that a major component of dermatomal block during intercostal catheterisations may be secondary to paravertebral spread.
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Ten patients, with a range of illness severity, received a continuous 8-hour infusion of undiluted propofol for sedation while undergoing mechanical ventilation in a general intensive care unit. The level of sedation was assessed hourly and measurements were made of haemodynamic, respiratory, haematological and biochemical variables. Sedation remained satisfactory in most patients throughout the study period, with only occasional alterations in infusion rate, and eight patients required further sedative therapy within 45 minutes of discontinuation of the propofol infusion. ⋯ Adrenal steroidogenesis was not inhibited significantly. Propofol infusion proved to be a useful and readily controllable sedative agent, and discontinuation of the drug was followed by rapid recovery in most cases. The critically ill may be particularly sensitive to the cardiovascular depressant properties of the drug.
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A tubular gauze mask suitable for inhalational anaesthesia for bronchoscopy, designed by Wilhelm Brünings, is described.
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Comparative Study
Anaesthesia for laparoscopy. A comparison of five techniques including propofol, etomidate, thiopentone and isoflurane.
This is a report about five anaesthetic techniques for laparoscopy. Propofol and etomidate were used for total intravenous anaesthesia. Propofol, etomidate and thiopentone were used as induction agents prior to inhalational anaesthesia with isoflurane and nitrous oxide. ⋯ Recovery was the most rapid following total intravenous anaesthesia with propofol. Postoperative side effects were much lower after propofol. No difference was observed between the groups with regard to changes in arterial blood pressure and heart rate.
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Comparative Study
Comparison of two regional techniques for postoperative analgesia in children following herniotomy and orchidopexy.
This study compares the quality and duration of analgesia in two groups of patients aged between 1 and 13 years who received either caudal anaesthesia with plain bupivacaine 0.25% or an iliohypogastric and inguinal nerve block combined with skin infiltration using bupivacaine 0.25% with adrenaline 1:200,000. The results indicate no significant difference in the duration or quality of the analgesia provided by the two techniques. There was no difference in the incidence of vomiting or the time of first micturition between the two groups.