British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Effect of continuous low-dose intravenous diltiazem on epidural fentanyl analgesia after lower abdominal surgery.
The postoperative opioid-sparing effects of systemic L-type calcium channel blockers are controversial. We investigated whether the postoperative analgesic effect of epidural fentanyl was enhanced by i.v. infusion of diltiazem at a rate that would minimize any cardiovascular depressant effect. ⋯ Continuous i.v. infusion of diltiazem did not reduce epidural fentanyl consumption when administered at dosages having minimal haemodynamic depressant effects.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of L-bupivacaine 0.75% and lidocaine 2% with bupivacaine 0.75% and lidocaine 2% for peribulbar anaesthesia.
L-Bupivacaine has a safer side-effect profile than bupivacaine. We compared the efficacy of a mixture of L-bupivacaine 0.75% and lidocaine 2% with bupivacaine 0.75% and lidocaine 2% for peribulbar anaesthesia in cataract surgery. ⋯ A mixture of bupivacaine 0.75% and lidocaine 2% provides faster onset time than a mixture of L-bupivacaine 0.75% and lidocaine 2%.
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We assessed the accuracy and precision of a new near-patient testing system (Hemochron Response) by measuring prothrombin time and activated partial thromboplastin time (PT and APTT) in 50 patients undergoing cardiac surgery using cardiopulmonary bypass and comparing the results with laboratory assays. ⋯ We found good agreement in the PT and clinically acceptable levels of agreement in the APTT during the pre-bypass period. After bypass, bias became greater for both PT and APTT and the limits of agreement could be clinically unacceptable.
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Insertion of a needle into the lumbar subarachnoid space may cause damage to the spinal cord. Current techniques to identify a safe interspace have limitations. Ultrasound was investigated as a means to improve anatomical accuracy. ⋯ These results suggest that ultrasonography may be a useful adjunct to safe subarachnoid anaesthesia.
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We present a case of paradoxical air embolism in a patient undergoing neurosurgery of the posterior fossa in the sitting position. Paradoxical air embolism was detected in the descending aorta by a transoesophageal Doppler probe, which was inserted primarily for non-invasive haemodynamic monitoring. The patient suffered no serious complications of paradoxical air embolism and recovered well. We suggest that paradoxical air embolism can be detected intraoperatively not only by transoesophageal echocardiography, but also with a transoesophageal Doppler probe.