British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Analgesic efficacy of paracetamol and diclofenac in children receiving PCA morphine.
We studied 80 children, aged 5-13 yr, who received PCA with morphine after appendicectomy using a standardized tracheal general anaesthetic. All patients received morphine 0.1 mg kg-1 before surgical incision and all had wound infiltration with bupivacaine 1 mg kg-1 at the end of surgery. ⋯ Analgesia, as assessed by movement pain scoring, was significantly improved by the addition of diclofenac despite lower morphine consumption. Adverse effects and duration of PCA were comparable in the four groups.
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Comparative Study Clinical Trial Controlled Clinical Trial
Comparison of bispectral index, 95% spectral edge frequency and approximate entropy of the EEG, with changes in heart rate variability during induction of general anaesthesia.
We have compared bispectral index (BIS), 95% spectral edge frequency (SEF) and approximate entropy (ApEn) in 37 patients during induction and recovery from a short general anaesthetic. Heart rate variability (HRV) was also compared during induction only. These indices were noted at the start of induction, when a syringe held between the thumb and fingertips was dropped, at insertion of a laryngeal mask or tracheal tube (tube insertion), at incision, at the end of surgery, on return of the gag reflex and when the patient could follow a verbal command. ⋯ Using logistic regression, the indices were compared both individually and in combination as to the power of distinguishing awake (at pre-induction) from asleep (at tube insertion) states. BIS had the best predictive power, with a sensitivity of 97.3%, specificity 94.4%, positive predictive value 94.7% and negative predictive value 97.1%. A combination of the indices conferred no additional predictive advantage.
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Gastric pressure and volume were measured in 20 pregnant women during emergency Caesarean section under general anaesthesia with neuromuscular block. Mean gastric pressure was 11 (range 4-19) mm Hg and we can predict that 99% of women undergoing emergency Caesarean section with neuromuscular block are likely to have gastric pressures of less than 25 mm Hg (mean + 3 SD). ⋯ Gastric pressure decreased significantly after delivery (P < 0.001) to 8 mm Hg. Although we measured large gastric volumes (mean 112 (range 20-350) ml), there was no correlation between gastric volume and gastric pressure.
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Case Reports
Failure to prevent an anaphylactic reaction to a second neuromuscular blocking drug during anaesthesia.
Skin testing is used widely to determine the drug responsible for an anaphylactic reaction during anaesthesia. When a neuromuscular blocking drug in incriminated as the cause of a reaction, it is usual for neuromuscular blocking drugs which do not produce positive skin tests to be considered safe for subsequent use during anaesthesia. We describe three patients in whom false negative skin tests led to a second severe anaphylactic reaction to another neuromuscular blocking drug.