British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Caudal anaesthesia with 0.375% ropivacaine or 0.375% bupivacaine in paediatric patients.
We have determined the effectiveness and degree of motor block produced by the new local anaesthetic, ropivacaine, when used for caudal anaesthesia in children. We studied 60 children, aged 3-6 yr, ASA I, allocated randomly in a double-blind manner, to receive one of two local anaesthetics: 0.375% ropivacaine 1.0 ml kg-1 or 0.375% bupivacaine 1.0 ml kg-1. Patients were anaesthetized with continuous infusion of propofol 200 micrograms kg-1 min-1. ⋯ The ropivacaine group showed a shorter duration of motor block than the bupivacaine group (P < 0.05). Postoperative analgesia was required at a mean time of 5 (SD 3.2) h in the ropivacaine group compared with 5 (2.8) h in the bupivacaine group. These findings suggest that caudal anaesthesia with ropivacaine in paediatric patients is effective and produces less motor block in the postoperative period.
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Randomized Controlled Trial Clinical Trial
Effect of different doses of inhaled nitric oxide on pulmonary capillary pressure and on longitudinal distribution of pulmonary vascular resistance in ARDS.
Inhaled nitric oxide lowers pulmonary capillary pressure (PCP) in animals and in patients with acute respiratory distress syndrome (ARDS). A dose-response relationship in patients with ARDS has not yet been established. Therefore, we studied the effects of four concentrations of nitric oxide (1, 10, 20 and 40 volumes per million (vpm)) in random order, on PCP in 19 patients with ARDS. ⋯ In both groups, the nitric oxide-induced decrease in pre-capillary vascular resistance was small with a maximum effect at 1 vpm. In ARDS, vasodilatation of pre-capillary vessels is achieved at low concentrations of nitric oxide, whereas the effect of nitric oxide on postcapillary vessels is variable. Higher concentrations may be required for optimal post-capillary vasodilatation in a subgroup of ARDS patients.
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Minimally invasive direct coronary artery bypass grafting (MIDCAB) is becoming a popular adjunct to standard cardiac bypass surgery in selected patients with accessible single or double vessel disease. However, the limited anterior thoracotomy used to access the heart involves trauma to the muscle tissue during removal of the fourth costal cartilage and a small piece of connected rib, perhaps leading to more severe postoperative pain compared with patients undergoing routine sternotomy. Intrathecal opioids can be used but have limited therapeutic duration and there is concern regarding anticoagulation. We present a case where soft tissue catheters were placed into the depths of the surgical wounds and pain was diminished greatly by intermittent regular infiltration with bupivacaine.
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Case Reports
Extradural anaesthesia for caesarean section in a patient with syringomyelia and Chiari type I anomaly.
We describe elective Caesarean section performed under extradural anaesthesia in a parturient with symptomatic syringomyelia and coexisting Chiari type I anomaly. Syringomyelia is reviewed and the anaesthetic implications of the condition discussed. Anaesthesia should be directed primarily at avoidance of increased intracranial pressure, which can cause sudden deterioration in these patients.
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We have examined the short-term effects of three volatile anaesthetics, halothane, isoflurane and desflurane, on mucociliary activity in the rabbit maxillary sinus in vivo. Mucociliary activity was recorded photoelectrically and the signal processed by fast Fourier transformation. Administration of 1.0 MAC of halothane, isoflurane or desflurane caused a temporary increase in mucociliary activity, with mean peak responses of 47.8 (SEM 13.0)%, 44.0 (9.6)% and 45.1 (23.7)% (n = 6), respectively. ⋯ Atropine pretreatment did not affect, whereas CP-99 significantly reduced, the response to desflurane. We conclude that the NK1-mediated response was most pronounced for desflurane which is considered the most airway irritating compound of the three. It is likely that the size of the NK1-mediated response reflects the airway-irritating properties of the volatile anaesthetic used.