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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Randomized Controlled Trial Comparative Study Clinical Trial
End-tidal concentrations of halothane and isoflurane during induction of anaesthesia in young and elderly patients.
Twenty-two young (18-32 yr) and 22 healthy elderly (60-80 yr) patients received either halothane or isoflurane for maintenance of anaesthesia during controlled ventilation. End-tidal fractional concentrations (FE) of the agents were measured for 20 min after their introduction into inspired gas and the increase in end-tidal concentrations of the two agents was compared during induction of anaesthesia using the ratios of FE to the inspired fraction (FI). ⋯ This suggests slower induction of anaesthesia in the elderly if equipotent concentrations of isoflurane are used; the clinical significance of this difference is probably small. Mean FE:FI ratios for halothane in elderly patients were similar to those in the young throughout induction of anaesthesia.