British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Hydroxyethylstarch compared with modified gelatin as volume preload before spinal anaesthesia for Caesarean section.
We studied 90 patients undergoing elective Caesarean section under spinal anaesthesia who received lactated Ringer's solution 1000 ml with up to 1000 ml of modified gelatin, lactated Ringer's solution 1000 ml with up to 1000 ml of 6% hydroxyethylstarch or only up to 1000 ml of 6% hydroxyethylstarch. Lumbar puncture was performed as soon as 500 ml of the colloid were infused. ⋯ In both groups receiving the 2000 ml preload, packed cell volume (PCV) values decreased by more than 20%, which may be of concern in patients already presenting with mild anaemia. In patients who received the colloid without the crystalloid, PCV values decreased by 14% but the risk of severe hypotension was comparable with the crystalloid-gelatin combination.
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Randomized Controlled Trial Clinical Trial
Hypotension during subarachnoid anaesthesia: haemodynamic effects of colloid and metaraminol.
We have studied 45 patients, aged 60-95 yr, receiving subarachnoid block for neck of femur fractures. Patient received either colloid (polygeline, Haemaccel) 8 ml kg-1 (n = 15), metaraminol 5 micrograms kg-1 and 1.7 micrograms kg-1 min-1 (n = 15) or a combination of both treatments to maintain systolic arterial pressure (SAP) between 75 and 100% of baseline. If necessary, additional colloid 2 x 4 ml kg-1 or metaraminol 3 x 2.5 micrograms kg-1 was given. ⋯ In the metaraminol group, initial decreases in SAP, SVRI and CVP were restored after 10-15 min and HR decreased after 12 min (P < 0.001). In the combined group, initial decreases in SAP and SVRI were restored after 4 and 16 min, and CVP, CI, SI and HR increased (P < 0.001). Metaraminol was more effective than colloid because it increased SVRI, whereas colloid increased CVP without significantly increasing CI.
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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.