British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Pre-emptive analgesia: comparison of preoperative with postoperative caudal block on postoperative pain in children.
We have compared in 25 children the effect of preoperative with postoperative caudal block on pain after circumcision in a double-blind, randomized study. After induction of anaesthesia, patients were allocated randomly to receive a caudal block either before (n = 14) or immediately after (n = 11) surgery. Postoperative pain was rated on a paediatric pain scale. ⋯ Using the Mann-Whitney U test (significance < or = 0.05) there was no significant difference in cumulative postoperative analgesic requirements within the first 48 h and in times to first analgesic administration between the groups. Cumulative pain score, assessed every 30 min for the first 8 h after operation, was significantly lower for those patients who received caudal anaesthesia after operation. Thus we could not demonstrate any advantage in performing caudal block before compared with after surgery.
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Randomized Controlled Trial Comparative Study Clinical Trial
Intraoperative glycaemic control in non-insulin-dependent and insulin-dependent diabetes.
We have compared intraoperative glycaemic control, insulin requirements and metabolic and endocrine variables in 40 non-insulin-dependent diabetic patients (NIDDM) and 40 insulin-dependent diabetic patients (IDDM) undergoing general anaesthesia for elective procedures. Two i.v. insulin regimens were used: continuous i.v. infusion (group A: 1.25 u.h-1) and repeated i.v. boluses (10 u./2 h). Blood concentrations of glucose were measured every 15 min from just before induction of anaesthesia until 2 h after surgery. ⋯ We conclude that mean glycaemic control, insulin requirements and development of ketone bodies in NIDDM and IDDM patients did not differ during the operative period, regardless of the insulin regimen used. Therefore, during the operative period, it is not necessary to modify the insulin regimen according to the type of diabetes. The consequences of increased plasma GH concentrations on glycaemic control in IDDM patients after operation are unknown.
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Randomized Controlled Trial Comparative Study Clinical Trial
Post-circumcision analgesia: comparison of topical analgesia with dorsal nerve block using the midline and lateral approaches.
Forty-five patients undergoing circumcision were allocated randomly to one of three study groups to compare topical analgesia with dorsal nerve block using the midline or lateral approach. Pain scores, side effects and analgesic requirements were recorded after surgery. ⋯ Fentanyl requirements and pain scores were similar in patients who received a dorsal nerve block using either the midline or lateral approach. The incidence of side effects after surgery was similar in all three groups.
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A postal survey of previous paediatric anaesthetic training, current paediatric experience and management of an infant pyloromyotomy was undertaken among consultant anaesthetists in the UK. A total of 851 questionnaires were returned, giving a response rate of 31%; 352 (41%) consultants had at least one paediatric list each week, 180 (21%) anaesthetized more than one infant less than 6 months old each month and 373 (44%) had obtained more than 6 months' specialist training. ⋯ Choice of technique was related to the duration of specialist paediatric training and when it was received, but not to current paediatric anaesthetic experience. The results are discussed in relation to recently published recommendations on paediatric anaesthetic services.