British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Recovery after electroconvulsive therapy: comparison of propofol with methohexitone anaesthesia.
We have studied prospectively 39 patients receiving a course of electroconvulsive therapy (ECT) for major depressive disorder; they were allocated randomly to receive either propofol or methohexitone for anaesthesia. Recovery after the third ECT treatment was assessed by finger tap and digit symbol substitution tests at 15, 30, 45, 60 and 90 min after induction. ⋯ There was no significant difference in psychometric recovery for drug type, duration of the seizure or initial severity of depression. These results suggest that the more rapid recovery rates noted with propofol in other procedures are not evident after electrically induced seizures.
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Randomized Controlled Trial Comparative Study Clinical Trial
Evaluation of an amethocaine gel preparation for percutaneous analgesia before venous cannulation in children.
We have evaluated the efficacy and safety of a preparation of 4% amethocaine gel in alleviating the pain of venous cannulation in children. In an initial open study of 148 children, clinically acceptable anaesthesia was achieved in 92% of cases. ⋯ There were no significant adverse effects noted in each group, although 37% of those children treated with amethocaine gel showed localized erythema at the application site. The results suggest that amethocaine gel has greater efficacy and a faster onset time than EMLA cream when used for this purpose in children.
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Randomized Controlled Trial Comparative Study Clinical Trial
Volume preloading is not essential to prevent spinal-induced hypotension at caesarean section.
We have compared the protective effect of 1000 ml preload with 200 ml preload of crystalloid solution, administered during the 10 min before spinal anaesthesia was induced, in 60 healthy women with no fetal compromise undergoing elective Caesarean section. The spinal anaesthetic was managed identically in both groups by an anaesthetist who was unaware of the volume of fluid administered. A prophylactic infusion of ephedrine 60 mg in Hartmann's solution 500 ml was given according to maternal arterial pressure. ⋯ There was no significant difference in ephedrine requirements between the two groups or in the incidence, severity or duration of hypotension: 10 women in the 1000-ml group, five episodes lasting > or = 3 min compared with nine women in the 200-ml group, four lasting > or = 3 min. There was no difference between neonates in each group. We have now abandoned the routine of preloading before regional anaesthesia.
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Editorial Comment
Volume preloading, spinal hypotension and caesarean section.
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I have evaluated in vitro methods of increasing the flow rate of clear fluids through an i.v. cannula at room temperature. These included, alone and in combination: increasing the height of a gravity-fed system; increasing the i.v. cannula diameter, manual compression of the lower drip chamber and the use of pressure bags. ⋯ The combination of these two tripled the overall flow to nearly 600 ml min-1. Manual compression of the drip chamber, despite producing peak pressures of more than 100 cm H2O, was an inefficient method of improving flow compared with an external pressure bag.