British journal of anaesthesia
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We have assessed postoperative delirium in 24 patients undergoing thoracotomy for pulmonary malignancy throughout their stay in hospital. Arterial oxygen saturation was measured with a pulse oximeter on the night before operation and on the second night after operation. Five patients (21%) developed clinically significant postoperative delirium, and delirium occurred in all patients who had inadequate oxygenation. ⋯ When patients were delirious, the first treatment of choice was supplementary oxygen and all patients were treated successfully by this simple regimen. In two patients, supplementary treatment with zuclopenthixol 6 mg daily was necessary. We conclude that hypoxaemia may be a contributing factor in postoperative brain dysfunction, as postoperative delirium was associated with hypoxaemia and was treated successfully with supplementary oxygen.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of a bupivacaine-clonidine mixture with plain bupivacaine for caudal analgesia in children.
In a randomized, double-blind study in children undergoing elective orthopaedic surgery, we have assessed the clinical value of combining clonidine with bupivacaine for caudal analgesia. Forty-six children, aged 1-10 yr, were allocated randomly to two equal groups to receive 0.25% bupivacaine 1 ml kg-1 combined with either normal saline 1 ml (group A) or clonidine 2 micrograms kg-1 in normal saline 1 ml (group B). Mean (SD) duration of caudal analgesia for groups A and B were 5.2 (1.2) h and 9.8 (2.1) h, respectively (P < 0.0001). ⋯ There was no significant difference in the incidence of side effects between the two groups. The longer duration of sedation in group B (9.1 (2.5) h) resulted partly from the sedative effect of clonidine and partly from the longer duration of analgesia provided by clonidine. We conclude that, when added to bupivacaine, clonidine improves the efficacy of caudal analgesia in children.
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Randomized Controlled Trial Comparative Study Clinical Trial
Changes in haemodynamic variables during transurethral resection of the prostate: comparison of general and spinal anaesthesia.
We have compared changes in haemodynamic variables before and during transurethral resection of the prostate in 22 patients under general or spinal anaesthesia. In the general anaesthetic group there was a significant decrease in cardiac output (mean 32% (SEM 5%)) and mean arterial pressure (14% (3%)) after induction of anaesthesia and a significant decrease (27% (3%)) in heart rate before the start of resection. ⋯ We conclude that with both these anaesthetic techniques the greatest changes in haemodynamic variables occurred shortly after induction, and that these changes were greater during general than spinal anaesthesia. The resection period was not associated with significant haemodynamic changes.