British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Caudal clonidine for postoperative analgesia in adults.
We have assessed the analgesic efficacy and side effects of caudally administered clonidine in a prospective, randomized, double-blind, placebo-controlled study. We studied 64 adult patients undergoing elective haemorrhoidectomy. Caudal block was performed in all patients using a mixture of 0.5% bupivacaine 35 mg with 2% lidocaine 140 mg and epinephrine 5 micrograms ml-1. ⋯ Clonidine 75 micrograms was added in group C and saline 1 ml in group S. Median time to first analgesic requirements was significantly longer in group C (mean 729 (SD 120) min) than in group S (276 (131) min) (P = 0.01). Bradycardia occurred in seven patients in group C but did not affect mean arterial pressure.
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Randomized Controlled Trial Clinical Trial
Oral preanaesthetic medication for children: double-blind randomized study of a combination of midazolam and ketamine vs midazolam or ketamine alone.
Anxiolysis and sedation with oral midazolam are common practice in paediatric anaesthesia. However, good or excellent results are seen in only 50-80% of cases. For this reason, we investigated if addition of a low dose of oral ketamine (MIKE: ketamine 3 mg kg-1, midazolam 0.5 mg kg-1) resulted in better premedication compared with oral midazolam 0.5 mg kg-1 or ketamine 6 mg kg-1 alone, in a prospective, randomized, double-blind study. ⋯ In summary, significantly better anxiolysis and separation were observed with a combination of ketamine and midazolam, even in awake children (sedation was not successful according to the preset criteria), than with midazolam or ketamine alone. Duration of action and side effects of the combination were similar to those of midazolam. The combination of both drugs in strawberry flavoured glucose syrup (pH 4.5 approximately) is chemically stable for 8 weeks.
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To understand the sequential response of the autonomic nervous system to pregnancy, we studied heart rate variability in 23 first trimester, 23 second trimester and 21 third trimester pregnant women. Twenty non-pregnant women were recruited as controls. Time and frequency domain measures of heart rate variability in three recumbent positions were compared. ⋯ When the position was changed from the supine to the right lateral decubitus, the percentage change in normalized high-frequency power correlated significantly and negatively with normalized high-frequency power in the supine position in non-pregnant controls (r = -0.56, P = 0.01) and in pregnant women in the first (r = -0.44, P = 0.034), second (r = -0.68, P < 0.001) and third (r = -0.68, P < 0.001) trimesters. These results indicate that autonomic nervous activity shifted towards a lower sympathetic and higher vagal modulation in the first trimester, and changed towards a higher sympathetic and lower vagal modulation in the third trimester as gestational age increased. The balance between the haemodynamic changes of pregnancy and aortocaval compression caused by the enlarging gravid uterus may be responsible for the biphasic changes in autonomic nervous activity during pregnancy.
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Randomized Controlled Trial Clinical Trial
Warm air sensation for assessment of block after spinal anaesthesia.
We have evaluated a new method of assessing dermatomal sensory levels after regional anaesthesia based on warm sensation. Sensory levels were assessed in 30 patients after spinal anaesthesia using a respiratory gas humidifier, adapted to deliver a constant flow of warm air at 40 +/- 0.2 degrees C. ⋯ The median difference in dermatomal levels between the two methods of assessment was 0 (interquartile range 0-1) (P = 0.65). We conclude that the warm air method compares favourably with ethyl chloride spray and both can be used interchangeably.
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Editorial Comment
Postoperative residual curarization and evidence-based anaesthesia.