British journal of anaesthesia
-
Randomized Controlled Trial Clinical Trial
Evaluation of the analgesic effect of metoclopramide after opioid-free analgesia.
Metoclopramide may enhance opioid analgesia, but it is not known if the drug is analgesic itself. This question was examined in a double-blind, randomized study of 38 patients undergoing knee arthroscopy with opioid-free anaesthesia comprising propofol, isoflurane and nitrous oxide in oxygen. At the end of surgery, patients received either metoclopramide 0.5 mg kg-1 or placebo i.v. ⋯ There were no significant differences between the groups in the patterns of pethidine consumption. However, the VAS-pain scores tended to be smaller in the metoclopramide group; this difference was significant 30 min after operation. These results do not demonstrate conclusively a clinically relevant analgesic action of metoclopramide.
-
Case Reports
A bifurcated endobronchial tube in the management of laryngotracheo-oesophageal cleft repair.
We describe the management of laryngotracheo-oesophageal cleft Type III using a bifurcated endobronchial tube. When the cleft was opened for repair, we were able to obtain effective control of the airway, which is the main problem in this rare congenital anomaly. Commercial tubes are not available, so we made the tube on the day of surgery, immediately before operation.
-
Comparative Study
Spread of spinal anaesthesia for caesarean section in singleton and twin pregnancies.
We have compared the spread of spinal anaesthesia in parturients with singleton and those with twin pregnancies. Fifty-five unpremedicated patients with uncomplicated pregnancy scheduled for Caesarean section were allocated to two groups: group I = 35 singleton mothers; group II = 20 with twin pregnancy. Both groups received spinal anaesthesia with hyperbaric bupivacaine 10 mg (2 ml of 0.5%). ⋯ We found a statistically significant difference in onset and maximal cephalad spread of spinal anaesthesia (group I median T5, range T8-T4; group II T3, range T6-T2). The mechanisms of higher cephalad spread of spinal anaesthesia in parturients may be a decrease in cerebrospinal fluid volume secondary to shunting of blood from the obstructed inferior vena cava to the extradural venous plexus and increased nerve sensitivity to local anaesthetics because of increased concentrations of progesterone. The twin pregnancy group had heavier, larger uteri and greater daily production of progesterone.