British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of four local extradural anaesthetic solutions for elective caesarean section.
We have examined a combination of two local anaesthetics to see if the resultant solution is superior to the agents individually. This study shows that a mixture of bupivacaine and lignocaine provided an excellent alternative to bupivacaine alone, and was superior to 2% lignocaine with adrenaline for elective Caesarean section. By reducing the dose of bupivacaine used, the combination may reduce the risk of cardiotoxicity.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of Ringer's acetate with 3% dextran 70 for volume loading before extradural caesarean section.
We have studied haemodilution and cardiovascular responses to i.v. hydration with either 3% dextran 70 (Dx70) or Ringer's acetate using a non-invasive cardiac output monitor (BoMed NCCOM3-R7) in 40 healthy parturients undergoing Caesarean section under extradural anaesthesia. Haemodilution was more pronounced, and central venous pressure, mean arterial pressure and cardiac index maintained at greater values, after treatment with Dx70. ⋯ In spite of these maternal changes, there were no differences in neonatal bioimpedance or values of haemoglobin, PCV, albumin and COP in umbilical cord blood, and only one case of respiratory distress. We conclude that colloids may be preferable to crystalloids for circulatory preload for extradural Caesarean section, as greater haemodynamic stability was maintained and increases in lung water avoided.
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We describe a patient who developed a 7th cranial nerve palsy following an extradural blood patch; full recovery followed. The likely aetiology is discussed.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of i.m. ketorolac trometamol and morphine sulphate for pain relief after cholecystectomy.
I.m. ketorolac trometamol 30 mg was compared with morphine sulphate 10 mg after cholecystectomy in a double-blind, multiple dose, randomized study of 100 patients. Assessments of pain were made immediately after operation (day 1), and the next morning (day 2). Pain intensity (verbal response score and visual analogue scale) was recorded before injection and then over a 6-h period. ⋯ Ketorolac produced significantly less analgesia than morphine on day 1, but on day 2 the two drugs produced a similar effect. Blood loss was not increased by ketorolac, although platelet function was impaired. Repeated i.m. administration of ketorolac did not produce any serious adverse effects.