Anaesthesia
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An injector gun of the type developed for vaccinations was used to perform intercostal nerve blocks. Analgesia was achieved in all patients to some degree, but the effectiveness of the technique was limited by the currently available local anaesthestics.
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A clinical study of the use of intrathecal morphine in two groups of surgical patients, 32 in all, showed that the morphine provided very powerful and prolonged analgesia with little disturbance of cerebral function. When combined with a spinal block it did not interfere with the action of the spinal anaesthetic. ⋯ The depression was sufficient to induce carbon dioxide narcosis in two patients. It is suggested that the dose of intrathecal morphine in the very elderly should be very severely restricted as they appeared to be unduly sensitive to the respiratory depressant effect of morphine when given intrathecally.
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Letter Case Reports
The use of the fibre-optic bronchoscope for the passage of a double lumen tube.
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Randomized Controlled Trial Clinical Trial
Halothane uptake and nitrous oxide concentration. Arterial halothane levels during Caesarean section.
The effect on halothane uptake of changing the nitrous oxide concentration during the first few minutes of a general anaesthetic for Caesarean section was investigated. In 10 mothers anaesthesia was maintained with halothane 0.4%, nitrous oxide 33% and oxygen 66%. In 10 others the sole difference in anaesthetic technique was that the ratio of nitrous oxide to oxygen was reversed for the first 3 minutes only. ⋯ Cord blood concentrations between the two groups were comparable. The difference in halothane levels is a demonstration of the influence of the concentration effect of nitrous oxide on the uptake of halothane, the second gas effect. The relevance of anaesthetic uptake to obstetric anaesthesia and awareness is discussed.
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Morphine (2--6 mg) injected into the epidural space was ineffective in relieving the pain of labour in eight patients. Morphine (2 mg) injected into the epidural space of 60 patients whilst they were undergoing Caesarean section was associated only modestly, if at all, with a diminished incidence of postoperative pain and discomfort, when compared with the epidural injection of saline in 60 patients matched for type of operation and type of anaesthesia. A relatively high incidence of postoperative vomiting was noted among the patients who received morphine.