Anaesthesia
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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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Systemic mastocytosis is a rare disorder characterised by the infiltration of many tissues by abnormal numbers of mast cells. Life-threatening episodes of bronchospasm and hypotension are common in response to a variety of triggers which cause mast cell degranulation. ⋯ Cardiovascular data, together with blood histamine levels and thrombin times, indicated that mast cell degranulation did not occur. A review of the current literature concerning mast cell disease as it relates to anaesthesia is presented and suggestions for the safe management of such cases are given.
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A case is presented of retrobulbar haemorrhage following anaesthesia for the removal of a chicken bone from the pharynx of a patient with systemic lupus erythematosus. The aetiology and treatment are discussed.
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The development of a tactile clinical test of the positioned orotracheal tube is described which allows confirmation of its location within the larynx. It was possible, after preliminary experience with the test, to confirm laryngeal placement confidently in an average of 97% of cases in two concurrent series each of which consisted of 100 patients. ⋯ The implications of this test are discussed in relation to difficult intubation, obstetric anaesthesia, the teaching of applied anatomy and checking by their trainers of intubations performed by very junior anaesthetists. Familiarity with this test should be considered essential for its reliable implementation.