British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Influence of preoperative gastric aspiration on the volume and pH of gastric contents in obstetric patients undergoing caesarean section.
Aspiration of gastric contents, the most common anaesthetic cause of maternal mortality, is decreased by emptying of the stomach and the use of antacids and H2-receptor antagonists. One hundred and eighty-three mothers presenting for emergency Cesarean section were allocated to three groups. In group 1, the stomach was emptied before operation via an orogastric tube and thereafter 30 ml of sodium citrate 0.3 mol litre-1 was ingested 5-15 min before induction of general anaesthesia (our usual practice). ⋯ However, the use of ranitidine and sodium citrate is preferred at subsequent times. Although our data show that preoperative gastric emptying decreased the mean intragastric volumes before Caesarean section, the number of patients at risk of acid aspiration was not reduced. In view of these findings and the unpleasantness of orogastric intubation, we suggest that routine preoperative gastric aspiration via an orogastric tube is not justified, although the manoeuvre should still be used following a recent meal.
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We have examined, under reproducible conditions, the resistance to airflow of complete anaesthetic breathing systems (Magill, Coaxial Lack, Parallel Lack and Bain systems) and components of these systems. All systems had resistances within the recommended ranges at all flows likely to be experienced in normal clinical practice. The Magill system had the lowest resistance under all conditions. It is concluded that comparisons should be made only between complete breathing systems.
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After extradural blockade failed to extend sufficiently for elective Caesarean section, spinal anaesthesia was performed using 1.6 ml of hyperbaric 0.5% bupivacaine solution in 8% glucose (Marcain Heavy). The patient rapidly developed sensory blockade to the level of T2, and became distressed and dyspnoeic. ⋯ Despite i.v. ephedrine and fluid loading, severe hypotension occurred, which responded subsequently to further doses of ephedrine and infusion of colloid. A healthy infant was delivered by Caesarean section.
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Randomized Controlled Trial Clinical Trial
Low-dose intrathecal diamorphine analgesia following major orthopaedic surgery.
In a randomized double-blind study we examined the effect of adding diamorphine 0.25 mg and 0.5 mg to intrathecal bupivacaine anaesthesia for major orthopaedic surgery. Duration of postoperative analgesia was considerably greater in patients given either doses of intrathecal diamorphine than in a control group of patients given bupivacaine alone (P less than 0.001). However, there was no significant difference between the two diamorphine doses (0.25 mg and 0.5 mg), each providing prolonged analgesia (10.8 and 9.9 h, respectively). Although there was no evidence of late respiratory depression, the frequency of adverse effects, in particular urinary retention, nausea and vomiting, was high in both groups receiving intrathecal diamorphine.
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Randomized Controlled Trial Clinical Trial
Recovery of neuromuscular function after infusion or intermittent bolus doses of atracurium or vecuronium.
Neuromuscular block and postoperative recovery of grip strength and peak expiratory flow (PEF) were compared in patients receiving atracurium or vecuronium administered by continuous infusion or intermittent bolus doses. The same total dose of atracurium (0.92-0.98 mg kg-1) or vecuronium (0.16-0.18 mg kg-1) was given by both methods. A similar degree of neuromuscular block was attained in all groups. ⋯ This was most marked following infusion of vecuronium (less than 50%). Grip strength recovered in all groups in 30-60 min. PEF was still significantly less than control value at 90 min in all groups receiving neuromuscular blocking drugs.