Anaesthesia
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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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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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An exercise in quality assurance during neuroanaesthetic procedures identified uncontrolled re-use of armoured latex rubber tracheal tubes as a risk factor associated with equipment failure. We recommend that such tubes should be used once only. Alternatively, tubes made from more stable materials, such as polyvinyl chloride and silicone rubber, are available for clinical evaluation.
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Randomized Controlled Trial Comparative Study Clinical Trial
Controlled release morphine tablets: a double-blind trial in patients with advanced cancer.
Eighteen of 27 patients with pain due to advanced cancer, completed a randomised crossover comparison of 4-hourly aqueous morphine sulphate and twice daily controlled release morphine tablets. There was no difference between the two regimens in analgesic efficacy or adverse effects, but there was an apparent improvement in quality of sleep on the controlled release tablets. After completion of the study, 17 patients continued with the latter medication for periods that ranged from 2 days to 94 weeks (median 6.5 weeks). Controlled release morphine tablets given twice daily provide a simpler and more convenient treatment regimen than a 4-hourly opioid for patients with cancer pain, once they have been stabilised.
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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.