British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Depth and duration of skin analgesia to needle insertion after topical application of EMLA cream.
We have determined the depth and duration of analgesia to needle insertion after topical application of EMLA cream (Eutectic Mixture of Local Analgesics). EMLA was applied for 30, 60, 90 and 120 min and the sensory and pain threshold depths were determined before analgesia (1.0 and 1.9 mm, respectively) and up to 4 h after the cream was removed from the skin. ⋯ For application times shorter than 120 min, the depth of analgesia increased during the period after removal of the cream. This suggests new guidelines for the use of this topical analgesic.
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A case is described of profound respiratory depression occurring 100 min after the extradural administration of fentanyl 100 micrograms to a patient undergoing Caesarean section.
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Clinical Trial Controlled Clinical Trial
Neuromuscular block with doxacurium (BW A938U) in patients with normal or absent renal function.
The characteristics of neuromuscular block induced by doxacurium were compared in patients with and without renal function. Seventeen patients with end stage chronic renal failure and 18 patients with normal renal function were anaesthetized with 0.5% halothane and nitrous oxide in oxygen and received doxacurium in an initial dose of 25 micrograms kg-1 (estimated from available data as an ED95 dose), with incremental doses of 5 micrograms kg-1. At the end of surgery, residual neuromuscular block was antagonized with either edrophonium 1.0 mg kg-1 or neostigmine 0.08 mg kg-1. ⋯ The rate of spontaneous recovery from doxacurium as indicated by the time for twitch height to recover from 0 to 5%, 5 to 10% and 10 to 25%, was not significantly different in the two groups. Antagonism of doxacurium was achieved more reliably with neostigmine than with edrophonium in both groups. The administration of doxacurium was associated with minimal cardiovascular effects.
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A 14-yr-old boy with fibrodysplasia ossificans progressiva (FOP) presented for surgery for bilateral division of his ossified masseter muscles. Patients with FOP may present problems to the anaesthetist, including difficulties with tracheal intubation, restrictive pulmonary disease and abnormalities of cardiac conduction. With our patient sedated the trachea was intubated using a fibrescope and anaesthesia was induced and maintained with nitrous oxide and enflurane in oxygen. Ventilation was controlled throughout surgery and recovery was uneventful.
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Multicenter Study Clinical Trial Controlled Clinical Trial
An open study of ropivacaine in extradural anaesthesia.
Ropivacaine 0.5%, 0.75% and 1.0% was investigated in an open study of extradural anaesthesia in three groups of 15 patients undergoing urological or orthopaedic surgery. Following a test dose of 3 ml of 1.0% lignocaine with 1:200,000 adrenaline, ropivacaine 20 ml was given in incremental doses over 4 min via a lumbar extradural catheter. The onset time for analgesia was short in all groups: T12 was blocked 4-6 min after the end of the injection of ropivacaine. ⋯ Bradycardia occurred in seven patients and was associated with hypotension in five. Backache was experienced after operation by four patients, and three patients complained of a brief mild headache. No late adverse events were seen.