British journal of anaesthesia
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The venous plasma concentration-time profiles of thiopentone were measured simultaneously over the first 30-40 min after induction of anaesthesia, in blood obtained from an arm vein and a vein in the foot, in nine healthy full-term women undergoing Caesarean section. Patients were tilted laterally to the left by from 8 to 18 degrees during the procedure. In all but two of the patients, the profiles from the arm and foot were virtually identical, suggesting that aortocaval compression was absent or insignificant. Therefore, the large intersubject variability in volume of distribution of thiopentone at Caesarean section is unlikely to be the result of aortocaval compression.
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Seventy-five patients requesting extradural analgesia for the relief of pain in labour underwent an ultrasound scan to measure the depth to the extradural space. There was a high degree of correlation between these measurements and the subsequent depth of insertion of the Tuohy needle. The advantages of the technique in clinical practice and as an aid to teaching, are discussed.
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Comparative Study
Maternal and umbilical cord plasma noradrenaline concentrations during labour with and without segmental extradural analgesia, and during caesarean section.
Serial measurements of maternal and umbilical cord plasma noradrenaline concentrations were obtained in 10 patients undergoing normal vaginal delivery with segmental extradural analgesia, in 10 patients undergoing normal vaginal delivery without extradural analgesia, and in 12 patients undergoing elective Caesarean section under general anaesthesia. Maternal noradrenaline concentrations increased significantly during delivery in all three groups, the peak concentrations occurring at delivery. ⋯ However, extradural analgesia did not affect the fetal noradrenaline concentrations. Since noradrenaline is probably required for the adaptation of the newborn to extrauterine life, the unaltered fetal response may be beneficial.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of fentanyl and halothane supplementation to general anaesthesia on the stress response to upper abdominal surgery.
The stress response to surgery and anaesthesia was studied in 20 patients undergoing cholecystectomy or vagotomy and pyloroplasty. Patients were anaesthetized with thiopentone and nitrous oxide; 10 patients received supplements of 0.5-1.5% halothane and the others fentanyl (mean 17 micrograms kg-1). ⋯ The hyperglycaemic response in the halothane group was greater than in the fentanyl group. Plasma noradrenaline concentrations increased in the group receiving halothane, but did not increase significantly in the group receiving fentanyl.