British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Randomized trial of novel tetracaine patch to provide local anaesthesia in neonates undergoing venepuncture.
Procedures such as venepuncture or heel prick are painful and may cause considerable stress to newborn infants. Topical local anaesthetics are effective for venepuncture but need to be applied for at least 60 min and the delivered dose will vary. We assessed a novel tetracaine-based self-adhesive patch in providing controlled local anaesthesia before venepuncture. ⋯ The tetracaine patch produced effective pain relief during the venepuncture procedure in both term and pre-term infants. There were no adverse effects, either local or systemic.
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Extension of a labour epidural for Caesarean delivery is thought to be successful in most cases and avoids the use of general anaesthesia. However, most previous studies that have estimated the failure rate of pre-existing epidural catheters were performed in small numbers of patients. ⋯ The augmentation of labour epidurals for Caesarean section using lidocaine 2% plus epinephrine is a reliable and effective technique. No factor associated with failure could be identified.
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A prototype paediatric propofol target-controlled infusion (TCI) system, the 'Paedfusor' has been developed. This system incorporates a paediatric pharmacokinetic data set and algorithm specific for children in a Graseby 3500 anaesthesia syringe driver. In this study we have evaluated the accuracy of the Paedfusor TCI system in children who underwent either cardiac surgery or cardiac catheterization procedures. ⋯ The Paedfusor performance was found to be within the accepted limits for use as a TCI system.
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Use of myocardial tissue Doppler imaging for intraoperative monitoring of left ventricular function.
Detection of myocardial ischaemia during surgery is usually by assessment of regional wall motion using two-dimensional transoesophageal echocardiography (TOE). Tissue Doppler imaging (TDI) may assist this assessment and improve its accuracy. ⋯ Intraoperative measurement of TDI in the anterior wall of the left ventricle is feasible and provides additional quantitative information on both regional and global systolic and diastolic function. We found changes in myocardial velocities indicating improvement in the systolic and impairment in the diastolic function of the anterior wall of the left ventricle immediately after mammary artery grafting.