British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Effect of addition of hyaluronidase to bupivacaine during axillary brachial plexus block.
We have studied in 22 patients the effect of adding hyaluronidase to bupivacaine during axillary brachial plexus block (BPB) in a double-blind design. Patients received BPB using bupivacaine 2 mg kg-1 with adrenaline 1 in 200,000, either with or without hyaluronidase 3000 iu, in a volume of 0.5 ml per 2.54 cm of the patient's height. ⋯ Hyaluronidase produced a significant reduction in the duration of anaesthesia. Changes in grip strength and skin temperature were useful in assessing the onset and progress of BPB.
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We have studied the effects of phonation and posture on the Mallampati classification of view of the pharyngeal structures. Differences between observers were allowed for by the experimental design and log-linear modelling. Sixty-four patients were assessed on the ward, sitting upright, with and without phonation, by each of two observers. ⋯ Differences between observers were non-systematic but substantial. About 25% of patients phonated spontaneously. It is recommended that anaesthetists make their own assessments of Mallampati classification, with the patient in either of the postures but always either with or without phonation, and thereby gradually "calibrate" their assessments against the degree of difficulty encountered in intubation.
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Randomized Controlled Trial Comparative Study Clinical Trial
Effect of verapamil on the cardiovascular responses to tracheal intubation.
We have studied the efficacy of verapamil in attenuating the cardiovascular responses to tracheal intubation in three groups of ASA grade I patients given verapamil 0.05 mg kg-1 or 0.1 mg kg-1 or saline 45 s before the start of laryngoscopy. Anaesthesia was induced with thiopentone 5 mg kg-1 i.v. and tracheal intubation was facilitated with vecuronium 0.2 mg kg-1. ⋯ In patients who received saline, there was a significant increase in mean arterial pressure and rate-pressure product associated with tracheal intubation. The increases were significantly less in verapamil-treated patients compared with those in the control group, although verapamil failed to prevent tachycardia caused by laryngoscopy and intubation.
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Case Reports
Delayed presentation of an extradural abscess complicating thoracic extradural analgesia.
Extradural abscess is a rare but recognized complication of extradural anaesthesia. Previous reports have been associated with a short time interval between extradural catheterization and presentation. We report a patient with rheumatoid arthritis, receiving steroid therapy, in whom an extradural abscess did not present until 23 days after the insertion of a thoracic extradural catheter to provide postoperative analgesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Maternal and fetal haemodynamic effects of spinal and extradural anaesthesia for elective caesarean section.
Serial haemodynamic investigations were performed in 32 women who were allocated randomly to receive either spinal or extradural anaesthesia for elective Caesarean section. Cardiac output was measured by Doppler and cross-sectional echocardiography at the aortic valve. Doppler flow velocity waveforms were recorded also from the umbilical artery. ⋯ Umbilical artery pH was less in the spinal group (7.22 vs 7.27), although no neonate was depressed at birth. The maximum percentage change in cardiac output and umbilical artery pulsatility index correlated with umbilical artery pH (r = 0.54, r = 0.72, respectively). There was no significant correlation with change in arterial pressure.