British journal of anaesthesia
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Reflex cardiovascular depression with vasodilation and bradycardia has been variously termed vasovagal syncope, the Bezold-Jarisch reflex and neurocardiogenic syncope. The circulatory response changes from the normal maintenance of arterial pressure, to parasympathetic activation and sympathetic inhibition, causing hypotension. This change is triggered by reduced cardiac venous return as well as through affective mechanisms such as pain or fear. ⋯ Treatment includes the restoration of venous return and correction of absolute blood volume deficits. Ephedrine is the most logical choice of single drug to correct the changes because of its combined action on the heart and peripheral blood vessels. Epinephrine must be used early in established cardiac arrest, especially after high regional anaesthesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Infusion of amino acid enriched solution hastens recovery from neuromuscular block caused by vecuronium.
We investigated the effect of an amino acid infusion on neuromuscular block produced by vecuronium, and on rectal temperature and surface temperature over the adductor pollicis muscle. Sixty adult patients undergoing general anaesthesia were randomly divided into four groups of 15 patients each: amino acid (AA)-post-tetanic count (PTC); AA-train-of-four (TOF); control (C)-PTC; or C-TOF group. In the AA-PTC and AA-TOF groups, after a bolus of vecuronium 0.1 mg kg(-1), a continuous infusion of an 18 amino acid enriched solution (AMIPAREN) was started at a rate of 166 kJ h(-1). ⋯ T1/T0 and T4/T1 in the AA-TOF group were significantly higher than in the C-TOF group, 40-120 and 50-120 min after vecuronium respectively (P<0.05). Rectal temperature and surface temperature over the adductor pollicis muscle in the AA-PTC and AA-TOF groups were significantly higher than in the control groups 50-120 and 100-120 min after vecuronium respectively (P<0.05). Infusion of amino acid enriched solution hastens recovery from neuromuscular block.
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Epidural anaesthesia is an important analgesia technique for obstetric delivery. During pregnancy, however, obesity and oedema frequently obscure anatomical landmarks. Using ultrasonography, we investigated the influence of these changes on spinal and epidural anatomy. ⋯ Thus far, palpation has been the only available technique to facilitate epidural puncture. Ultrasound imaging enabled us to assess the structures to be perforated. We anticipate that this technique will become valuable clinically.
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Randomized Controlled Trial Clinical Trial
Orally administered clonidine significantly reduces pain during injection of propofol.
We examined the analgesic effects of orally administered clonidine on pain induced by injection of propofol (Diprivan; 2,6-diisopropyl phenol). Female patients (n=81) were randomly allocated to one of two groups: oral clonidine (5.5 microg kg(-1)) followed by i.v. propofol and a control group given placebo followed by i.v. propofol. The median pain score in the group receiving clonidine, using a four-point scale (0=no pain, 1=minimal pain, 2=moderate pain, 3=severe pain) was 1 (0-2), significantly lower than in the control group [2 (1-3), median (25-75 percentiles), P<0.001].
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Case Reports
Intramuscular ketamine in a parturient in whom pre-operative intravenous access was not possible.
We describe the management of a 23-yr-old woman with extreme needle and mask phobia, presenting for an emergency Caesarean section for fetal distress. She also suffered from spina bifida cystica with no sensation from mid thigh. Regional anaesthesia, rapid sequence induction, and gaseous induction were not possible. She was managed successfully with i.m. ketamine followed by a more conventional anaesthetic technique.