British journal of anaesthesia
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Anaesthesia was induced with propofol 2.5 mg kg-1 followed by suxamethonium 1.5 mg kg-1 in six young healthy females undergoing laparoscopy. ECG was monitored continuously. ⋯ The bradycardia may be prevented by premedication with atropine. In contrast to thiopentone, propofol apparently lacks central vagolytic activity and may exert a central vagotonic effect which can exaggerate the muscarinic effects of suxamethonium.
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Randomized Controlled Trial Comparative Study Clinical Trial
Spinal anaesthesia with 0.5% bupivacaine 3 ml: comparison of plain and hyperbaric solutions administered to seated patients.
In a double-blind study, 0.5% bupivacaine 3 ml in plain (n = 10) or hyperbaric (n = 10) solution was injected intrathecally to 20 patients who were in the sitting position, to produce spinal anaesthesia for transurethral resection of prostate. No statistically significant differences were found in time to maximum cephalad spread of analgesia nor in the level reached. ⋯ There was no difference in the incidence of complete motor block, but a longer duration of lesser degrees of motor block was found with the plain solution (P less than 0.05). The plain solution produced a more predictable level of blockade.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of chloral hydrate and midazolam by mouth as premedicants in children undergoing otolaryngological surgery.
Chloral hydrate 25, 50 or 75 mg kg-1 or midazolam 0.4, 0.5 or 0.6 mg kg-1, all given by mouth in combination with atropine 0.03 mg kg-1, were compared as premedication in 248 children in a randomized, double-blind study. Chloral hydrate was significantly less palatable than midazolam. The anxiolytic effect of chloral hydrate 75 mg kg-1 was "good" in children younger than 5 yr, whereas the other doses of chloral hydrate, and all doses of midazolam, provided only "fair" anxiolysis in this age group. ⋯ The mean total recovery score (0-10) based on activity, ventilation, heart rate, conscious level and colour ranged between 5.8 and 6.8 at 10 min and between 9 and 9.5 at 70 min after extubation in all groups. Midazolam 0.5 mg kg-1 is recommended for children less than 5 yr of age and midazolam 0.4-0.5 mg kg-1 for older ones. Chloral hydrate 75 mg kg-1 provided good anxiolysis in both age groups; however, it was less palatable than the midazolam.
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Twenty-two anaesthetists participated in a study to assess the influence of occupational exposure to anaesthetic agents on mood (arousal and stress) and cognitive functions. In a cross-over design, each anaesthetist worked one day in a reference facility (for example, intensive care) and another day in a scavenged operating theatre where time-weighted exposure averaged nitrous oxide 58 p.p.m. and halothane 1.4 p.p.m. The results showed that arousal scores reached a peak in the middle of the theatre day, but this appeared to reflect the nature of operating theatre work rather than exposure. ⋯ Similarly, there was no evidence that exposure impaired performance of tasks assessing syntactic and semantic reasoning, verbal and spatial memory, sensory-motor reaction time and attention. Performance in these tasks was, however, sensitive to the cognitive demands of the tasks and to naturally varying non-exposure factors. It is concluded that, compared with the reference condition, the concentrations of anaesthetic agents found in actively scavenged operating theatres have no detrimental effect on either the mood or the cognitive functions of anaesthetists.
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Fetal aortic and umbilical blood flows were studied in 15 mothers before and during spinal (intrathecal) anaesthesia for elective Caesarean section, using a method combining real-time ultrasonography and a pulsed Doppler technique. Spinal anaesthesia with 0.5% bupivacaine hydrochloride 2.5 ml in 8% glucose monohydrate solution was administered after preloading with 2 litre of lactated Ringer's solution. Simultaneously with the subarachnoid injection, an infusion i.v. of ephedrine 50 mg in 500 ml normal saline was initiated. ⋯ Fetal heart rate increased (P less than 0.05) 30 min after the introduction of the spinal anaesthesia, but blood flows in the fetal descending aorta and umbilical vein were unaffected. The pulsatility index of the fetal blood velocity decreased (P less than 0.05) both in the fetal aorta and in the umbilical artery 30 min after induction of the spinal anaesthesia, indicating a possible decrease in the placental vascular resistance. We conclude that, when normotension is maintained in the mother with a preload infusion and an infusion of ephedrine, spinal anaesthesia for Caesarean section has no harmful effect on the fetal circulation.