Anaesthesia
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Randomized Controlled Trial Clinical Trial
Mental function and morbidity after acute hip surgery during spinal and general anaesthesia.
Forty elderly patients (mean age 78.9 years) undergoing acute surgery for hip fracture were given at random either spinal analgesia with bupivacaine 0.75% or general anaesthesia with diazepam, fentanly and N2O/O2. Mental function was studied pre-operatively with an abbreviated mental test and 1 week and 3 months postoperatively in both groups. Mortality and number of complications was similar in the two groups, but a shorter time of ambulation was seen in the spinal group compared to the general anaesthetic group. No persistent impairment in mental function was found after acute hip surgery under spinal or general anaesthesia and the only advantage of regional technique was a shorter time of ambulation.
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A case of an allergic reaction to Syntocinon (synthetic oxytocin) administered during Caesarean section is reported.
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The depth of the epidural space at different intervertebral interspaces was measured in 1000 parturients. Overall the median distance from the skin to the epidural space was 4.7 cm, but this varied with the lumbar interspace at which it was measured, being greatest at the third (L3-4) interspace (4.93 cm) and least at the first (L1-2) interspace (4.23 cm). The clinical significance of these findings is discussed.
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Bilateral compression of the jugular veins to raise temporarily cerebral venous pressure, is a manoeuvre recommended frequently in the immediate management of venous air embolism during neurosurgery. One method of compressing the neck veins is to inflate a pneumatic cuff secured around the neck with adhesive tape. This method of neck vein compression had been assessed in upright anaesthetised sheep and found to be an easily controlled and efficient way to raise the cerebral venous pressure. Advantages, dangers and potential problems associated with the use of an inflatable cuff in the clinical situation are discussed.