British journal of anaesthesia
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We reported previously that nitrous oxide induces pre-emptive analgesia that is partially antagonized by naloxone and totally antagonized by halothane. The aims of this study were to determine if halothane and isoflurane are similar in this respect and to examine if volatile anaesthetics antagonize the analgesic effect of exogenous opioids. ⋯ Neither halothane nor isoflurane alone altered the tail-flick response. We conclude that both halothane and isoflurane dose-dependently antagonized nitrous oxide analgesia but antagonized morphine-induced analgesia to a lesser extent.
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We have reviewed 5802 Caesarean sections performed during general anaesthesia. Our use of general anaesthesia had decreased from 83% in 1981 to 23% in 1994. ⋯ Asians and African/Afrocaribbeans were represented disproportionately because of the increased use of general anaesthesia in these patients. Exposure of trainees to obstetric general anaesthetics has decreased by one-third.
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We have studied the effects of crystalloid (Ringer's acetate 1 litre) preloading and subsequent spinal anaesthesia in 12 pre-eclamptic parturient patients undergoing elective Caesarean section. Maternal placental uterine artery circulation was measured using a pulsed colour Doppler technique with simultaneous measurement of maternal haemodynamic state. Despite preloading, mean maternal systolic arterial pressure (SAP) decreased significantly and marked maternal hypotension (SAP < 80% of baseline value) was recorded in two patients after induction of spinal anaesthesia. ⋯ In one patient, uterine artery PI increased significantly when SAP decreased to 71% of the baseline value, 14 min after induction of spinal anaesthesia. These results suggest that preload with crystalloid solution does not prevent maternal hypotension in pre-eclamptic patients, and that changes in uterine artery velocity waveforms were minor when SAP was 80% or more of baseline during spinal anaesthesia. These changes did not appear to have any major effect on the clinical condition of the neonate, as assessed by Apgar score and umbilical artery pH values.
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We have assessed the role of the cell-cell adhesion molecule, E-cadherin, in the pathogenesis of multiorgan failure in 24 intensive care patients with sepsis and varying degrees of organ dysfunction, compared with 21 healthy subjects. Plasma soluble E-cadherin (sE-cadherin) was measured by enzyme immunoassay. ⋯ Concentrations of sE-cadherin tended to increase with the severity of organ failure. We conclude that sE-cadherin is increased in inflammation and injury, and may be related to the degree of multiorgan failure after sepsis.