British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Subarachnoid anaesthesia with 0.5% bupivacaine: effects of density.
The effects of subarachnoid administration of 0.5% bupivacaine 4 ml in 8%, 5% or 0% glucose were investigated in a double-blind study in 30 women undergoing laparotomy through a lower abdominal incision. The onset time for maximum segmental spread of analgesia was 10-15 min for all solutions. Cephalad segmental spread of analgesia was three to four segments higher with the hyperbaric solutions (T4-5 v. ⋯ Duration of motor blockade generally decreased with increasing glucose concentration, only the hyperbaric solutions providing useful for abdominal surgery, with a duration of 1-1.5 h. Anaesthesia (halothane) was required in seven of 10 patients in the glucose-free group and in five of 20 in the hyperbaric groups. No occurrence of "post-spinal headache" was recorded in the study.
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In nine patients, with preoperative ICP monitoring, anaesthesia was induced with thiopentone 5 mg kg-1 given over 1 min, followed by pancuronium 0.1 mg kg-1. After manual hyperventilation with nitrous oxide and oxygen for 3 min they were given thiopentone 2.5 mg kg-1 over 30 s (phase 1); 30 s later laryngoscopy was performed and topical analgesia administered to the larynx. Endotracheal intubation was performed 1 min after spraying the cords (phase 2). ⋯ Although there was a significant decrease (P less than 0.05) in MAP at the end of the second dose of thiopentone, there were no other significant changes in ICP, MAP or PaCO2 throughout the study. In two patients there were transient decreases in cerebral perfusion pressure to less than 60 mm Hg. Although MAP increased in five of the patients during laryngoscopy and intubation, there was no increase in ICP, showing that the MAP was still within the autoregulatory limits.
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Randomized Controlled Trial Comparative Study Clinical Trial
Antagonism of alcuronium with edrophonium or neostigmine.
The reversal of alcuronium by edrophonium 1 mg kg-1 or neostigmine 35.7 micrograms kg-1 was compared in 23 patients undergoing elective ophthalmic surgery. Neuromuscular transmission was assessed by measuring the force of contraction of the adductor pollicis muscle in response to train-of-four supramaximal stimuli (2 Hz, 0.2 ms duration) delivered via surface electrodes to the ulnar nerve every 10 s. Anaesthesia was induced and maintained with Althesin, and patients were ventilated to normocarbia with 67% nitrous oxide in oxygen. ⋯ Recovery of the first contraction response of the train-of-four and of fade were more rapid after edrophonium. Although most patients were monitored for at least 30 min no re-curarization was seen. Comparison of the relative rates of recovery of the first contraction, and the response to train-of-four stimuli, suggests that edrophonium has a greater prejunctional effect than neostigmine.
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The results of early extubation after open heart surgery for congenital heart disease in 209 consecutive patients have been reviewed. No patient younger than 3 months of age, 52% of those between 3 and 12 months, and 88% of those older than 12 months had the tracheal tube removed in the operating theatre. Four patients required reintubation of the trachea, three because of respiratory difficulty and one because of cerebral oedema. ⋯ Twelve patients had PaO2 values less than 8.0 kPa after operation, despite adequate oxygen therapy. In four of these, this was related to persistent intracardiac shunting. It is concluded that early extubation after open heart surgery for congenital heart disease has minimal risk in carefully selected patients.
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The effect of isoflurane on cranial extradural pressure (EDP) was studied in 10 patients. In eight patients with normal intracranial pressure, the addition of 1.0% isoflurane to nitrous oxide plus fentanyl in oxygen anaesthesia, at physiological carbon dioxide tensions, did not cause any significant change in EDP; 1.5% resulted in a small but significant increase. ⋯ Mean arterial pressure (MAP) was decreased significantly at the higher isoflurane concentration. It was concluded that use of isoflurane is not contraindicated in patients with mass lesions, either at normocapnic or hypocapnic concentrations of carbon dioxide and would appear to be suitable for use in neurosurgical anaesthesia.