British journal of anaesthesia
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Clinical Trial Controlled Clinical Trial
Spinal anaesthesia for caesarean section. The use of 0.5% bupivacaine.
Subarachnoid anaesthesia was induced with 0.5% bupivacaine 2-3.5 ml in 33 women scheduled for elective Caesarean section. Three patients failed to develop adequate analgesia with bupivacaine but were managed satisfactorily with heavy cinchocaine. All the other patients developed adequate analgesia eventually. Since the spread of analgesia was uniquely dependent on posture a new hypothesis is presented to explain the distribution of intrathecal anaesthetic drugs in late pregnancy.
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Plasma concentrations of etomidate have been measured in six patients who required intermittent positive pressure ventilation following surgery. There was an approximately linear relationship between the plasma concentration and the rate of infusion of etomidate. ⋯ The decrease in the plasma concentration after discontinuing the infusion was consistent with a three-compartment pharmacokinetic model. The plasma terminal half-life was found to be about 5.5 h, and the clearance calculated to be 0.025 litre kg-1 min-1.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of effects of intraoperative and postoperative methadone: acute tolerance to the postoperative dose?
The effects of methadone 10 mg administered in two different clinical contexts, at induction of anaesthesia and following operation, were studied in two groups of patients undergoing elective total hip replacement. The intraoperative group received methadone 10 mg i.v. at induction of anaesthesia as part of a balanced anaesthetic technique. The postoperative group received methadone 10 mg i.v. following operation, extradural bupivacaine being used for the operative period. ⋯ Subsequently, the postoperative group had a significantly greater analgesic requirement which resulted in significantly greater plasma methadone concentrations the following morning. Thus, the administration of methadone following operation appeared to exert less analgesic effect than the same dose given during operation. The reasons for this are discussed.
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Randomized Controlled Trial Comparative Study Clinical Trial
Psychomimetic reactions after low-dose ketamine infusion. Comparison with neuroleptanaesthesia.
Low-dose ketamine anaesthesia was compared with neuroleptanaesthesia, in respect of immediate and longer-term psychomimetic reactions, in 40 female patients undergoing elective gynaecological surgery. Qualitatively, but not quantitatively, different psychomimetic reactions occurred in both groups. ⋯ Interviews after 3 months revealed a low frequency of psychomimetic reactions in both groups. However, 30% of all the patients (12) complained of impairment of intellectual function, and in seven patients this was severe enough to interfere with their ability to work.