British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
The modifying influence of anaesthesia on postoperative protein catabolism.
We studied two groups of six patients scheduled for gastrointestinal surgery; they were allocated randomly to receive high- or low-dose fentanyl anaesthesia. The confounding effect of protein balance, before the trauma of surgery, on postoperative nitrogen excretion was controlled by standardized protein intake before operation, supplemented by adequate calories. ⋯ The high-dose group had significantly lower postoperative excretion of ammonia and slightly lower excretion of urea and 3-methylhistidine. Low-stress anaesthesia may thus diminish postoperative catabolism, which could be important in frail patients by reducing mortality, ICU resources, or both.
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Randomized Controlled Trial Clinical Trial
Effect of ilioinguinal and iliohypogastric nerve block and wound infiltration with 0.5% bupivacaine on postoperative pain after hernia repair.
We have compared, in 40 adult males, the effect on pain in the first 24 h after herniorrhaphy of preincisional ilioinguinal and iliohypogastric nerve block and wound infiltration with 0.5% bupivacaine or saline. After operation, patients received morphine i.v. via a patient-controlled analgesia machine and visual analogue pain scores (VAS) at rest and on movement were recorded. The bupivacaine group consumed less morphine in the first 6 h after operation. ⋯ There was no significant difference in VAS scores at rest but there was a significantly higher pain score with movement in the saline group. We have shown that the combination of nerve block and wound infiltration reduces consumption of morphine in the first 24 h after herniorrhaphy. We have failed to show any effect of 0.5% bupivacaine beyond the first 6 h after operation.
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Injection of formalin into the hindpaw of a rat induces a biphasic response in pain-related behaviours, such that C-fibre activation during phase 1 triggers a state of central sensitization characterized by a longer lasting phase 2. As the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) may participate in processing of nociceptive inputs, we hypothesized that pentobarbitone and propofol, i.v. anaesthetics with known GABAA agonist properties, would interfere with development of central sensitization and thereby modify the phase 2 hyperalgesic response. ⋯ In contrast, propofol had no effect on phase 2 formalin-induced pain behaviour. Thus we conclude that pentobarbitone, but not propofol, produced pre-emptive analgesia in this model, presumably by suppressing noxious stimulation-induced central sensitization via activation of GABAA receptors.
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We have analysed, with the aid of an online database, the number of all types of contributions from scientists of various countries to four leading international anaesthesia journals (British Journal of Anaesthesia, Anaesthesia, Anesthesia and Analgesia and Anesthesiology) during the period 1987-1991. Although American and British publications played the leading roles in the total number of anaesthetic publications (40.4% and 32.5%, respectively), more detailed analysis revealed an unexpectedly high "publication output" of smaller countries, which sometimes exceeded those of larger nations (publications per million inhabitants: United Kingdom 41.9, Denmark 24.2, Sweden 15.4, Finland 15.3, Israel 14.6, Ireland 13.1, U. S. A. 11.9, Switzerland 11.0).
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Historical Article
A short history of fires and explosions caused by anaesthetic agents.
The first recorded fire resulting from the use of an anaesthetic agent occurred in 1850, when ether caught fire during a facial operation. Many subsequent fires and explosions have been reported, caused by ether, acetylene, ethylene and cyclopropane, and there has been one reported explosion involving halothane. ⋯ The use of flammable agents has decreased significantly in recent years and although fires and explosions from nonanaesthetic causes, for example gastrointestinal gases, skin sterilizing agents and laser surgery, may continue to occur, those from gaseous and volatile anaesthetic agents may now be of historical interest only. This article reviews some of the more relevant and enlightening reports of the past 150 yr.