Anaesthesia
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Comparative Study
Anaesthesia in the morbidly obese. A comparison of anaesthetic and analgesic regimens for upper abdominal surgery.
Seventy morbidly obese patients presented for upper abdominal surgery; 17% had pre-existing cardiovascular disease and 23% pre-existing respiratory disease. Twenty-eight patients received general anaesthesia, plus narcotic analgesia postoperatively, and 42 general anaesthesia plus thoracic epidural analgesia intra- and postoperatively. ⋯ Patients who had thoracic epidural analgesia required less volatile anaesthesia than the group who had general anaesthesia and narcotic analgesics. Postoperative respiratory complications were more common in patients with pre-existing cardiovascular and respiratory disease, and occurred less frequently in patients who had thoracic epidural analgesia.
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Two cases of profound bradycardia (one progressing to asystole) during orbital surgery where the relevant eye had been removed years earlier are reported. Cessation of stimulation was followed by recovery of heart rate. Intravenous atropine prevented further bradycardia.
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An etomidate infusion was used in the place of nitrous oxide during one lung anaesthesia for 40 patients undergoing thoracic surgery. Analgesia was provided by fentanyl. ⋯ There was no incidence of awareness or dreams. This technique provides satisfactory anaesthesia and oxygenation during thoracic surgery when one lung only is being ventilated.
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Randomized Controlled Trial Comparative Study Clinical Trial
Epidural buprenorphine for pain relief after major abdominal surgery. A controlled comparison with epidural morphine.
In a controlled trial epidural buprenorphine was compared with epidural morphine as the sole means of analgesia after major abdominal surgery. Bolus injections of buprenorphine 60 micrograms in 10 ml or morphine 2 mg in 10 ml of normal saline were given on demand for the first 48 hours postoperatively. Both drugs produced significant reduction in pain scores as assessed by the linear visual analogue scale and both produced prolonged analgesia at this dosage, which could be extended by further 'top-ups'. The authors conclude that, for postoperative epidural analgesia, buprenorphine may be the opiate of choice and the reasons for this are discussed.