British journal of anaesthesia
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A mother with the Klippel-Feil syndrome, congenital hydrocephalus and increased intracranial pressure presented for delivery by Caesarean section at 33 weeks because of pre-eclampsia. Anaesthetic management comprised awake intubation using the fibreoptic bronchoscope, followed by induction and maintenance of general anaesthesia for the delivery of a live male infant. This case report describes the problems arising under these circumstances and the relative merits of different anaesthetic techniques.
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Randomized Controlled Trial Clinical Trial
Transcutaneous electrical nerve stimulation in the management of acute postoperative pain.
Twenty patients undergoing decompressive lumbar laminectomy were randomly allocated, in a double-blind manner, to receive active or inactive transcutaneous electrical nerve stimulation (TENS) as part of the management of their postoperative pain. All patients received the same non-narcotic general anaesthetic. The efficacy of the TENS was assessed by using a patient-controlled analgesia system (PRODAC) which delivered morphine i.v. ⋯ In addition, plasma morphine concentrations were measured hourly for the first 6 h and again at 24 h. There was no statistical difference between the two groups in the number of patient demands for analgesia, morphine dose or plasma morphine concentration. TENS offered no advantage over a placebo in the management of acute postoperative pain in these patients.
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Comparative Study
Propofol reduces seizure duration in patients having anaesthesia for electroconvulsive therapy.
Twenty-five patients received either methohexitone 1.0 mg kg-1 or propofol 1.3 mg kg-1 to induce anaesthesia during two separate electroconvulsive therapy (ECT) treatments. A forearm was isolated before administration of suxamethonium 0.5 mg kg-1, so that unmodified seizure duration could be measured. ⋯ Median (quartile deviation) duration of seizure was reduced significantly after propofol (19.0 (9.0) s), compared with after methohexitone (33.0 (7.8) s). Therefore propofol may not be an appropriate anaesthetic for ECT because of its adverse effect on seizure duration.