British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Extradural bupivacaine with sufentanil for vaginal delivery. A double-blind trial.
The combination of sufentanil with bupivacaine plus adrenaline given extradurally for pain relief during labour was studied in a double-blind trial. One hundred and twenty patients were randomly divided into three groups and received a 10-ml extradural injection of sufentanil 15 micrograms + bupivacaine 12.5 mg + adrenaline 12.5 micrograms, sufentanil 7.5 micrograms + bupivacaine 12.5 mg + adrenaline 12.5 micrograms, or bupivacaine 12.5 mg + adrenaline 12.5 micrograms (control group). A second injection, which was given upon request, was identical to the first. ⋯ Moreover, the quality of analgesia was better and less bupivacaine was required, resulting in less motor blockade at delivery. There were no differences between the three groups in regard to Apgar scores. The only side effect of sufentanil was pruritus.
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Gas exchange was modelled by a Fortran program. Arterial blood-gas tensions have higher resolution than inert gas retentions in terms of distinguishing a single VA/Q compartment from a progressively broadening lognormal distribution. ⋯ The way in which the arterial blood-gas tensions vary with the variables of two and three-compartment distributions is described. Two- and three-compartment VA/Q distributions are derivable from either arterial blood-gas tensions or inert gas retentions.
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Comparative Study
Neuroleptic malignant syndrome and malignant hyperthermia. In vitro comparison with halothane and caffeine contracture tests.
The in vitro halothane and caffeine contracture tests have been performed on muscle tissue from six survivors of the neuroleptic malignant syndrome. The results, which are expressed in accordance with the criteria of the European MH Group, defined five of the subjects as MHN and one patient as MHE. It is concluded that there is no common pathophysiological link between the neuroleptic malignant syndrome and malignant hyperthermia.
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This study reports the experience of a department of paediatric anaesthesia with 234 continuous extradural anaesthetics performed in 229 children over a 15-month period. Fifty-nine of the children were aged 0-2 yr, 71 were aged 2-8 yr and 104 were older than 8 yr. The surgical procedures lasted more than 60 min (mean 150 +/- 10.6 min); all were carried out under light general anaesthesia. ⋯ After extradural anaesthesia with 0.25% bupivacaine with adrenaline 1:200000, minimal changes in HR or SAP occurred in children younger than 8 yr; in those older than 8 yr a significant decrease in both HR and SAP was observed. Changes in SAP were at their maximum 25 min after the extradural block and changes in HR were not statistically significant before the 25th min following injection of local anaesthetic. The catheter remained in place in 155 children for postoperative analgesia, mainly for the first 48 h.
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Randomized Controlled Trial Clinical Trial
Use of neostigmine in the antagonism of residual neuromuscular blockade produced by vecuronium.
Recovery from neuromuscular block produced by vecuronium was studied in 50 patients using electromyography and the train-of-four technique. Twenty patients received neostigmine 2.5 mg, 10 when the initial response of the train-of-four was 50% of control and 10 when it was 10%. ⋯ Neostigmine significantly reduced the time to 70% recovery of both ratios with both degrees of block, but neostigmine 5.0 mg did not give a substantially more rapid recovery than 2.5 mg. No evidence of a neostigmine-induced block was encountered. neostigmine 2.5 mg was rapidly effective in antagonizing vecuronium-induced block, even when initial recovery was only slight: there was no advantage in using neostigmine 5.0 mg.