British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of fentanyl and halothane supplementation to general anaesthesia on the stress response to upper abdominal surgery.
The stress response to surgery and anaesthesia was studied in 20 patients undergoing cholecystectomy or vagotomy and pyloroplasty. Patients were anaesthetized with thiopentone and nitrous oxide; 10 patients received supplements of 0.5-1.5% halothane and the others fentanyl (mean 17 micrograms kg-1). ⋯ The hyperglycaemic response in the halothane group was greater than in the fentanyl group. Plasma noradrenaline concentrations increased in the group receiving halothane, but did not increase significantly in the group receiving fentanyl.
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Comparative Study
Maternal and umbilical cord plasma noradrenaline concentrations during labour with and without segmental extradural analgesia, and during caesarean section.
Serial measurements of maternal and umbilical cord plasma noradrenaline concentrations were obtained in 10 patients undergoing normal vaginal delivery with segmental extradural analgesia, in 10 patients undergoing normal vaginal delivery without extradural analgesia, and in 12 patients undergoing elective Caesarean section under general anaesthesia. Maternal noradrenaline concentrations increased significantly during delivery in all three groups, the peak concentrations occurring at delivery. ⋯ However, extradural analgesia did not affect the fetal noradrenaline concentrations. Since noradrenaline is probably required for the adaptation of the newborn to extrauterine life, the unaltered fetal response may be beneficial.
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Ebstein's anomaly is a rare congenital malformation of the tricuspid valve, often associated with an atrial septal defect. Death occurs usually from cardiac arrhythmias. The successful use of a two-catheter technique for elective Caesarean section with extradural analgesia is described and the hazards associated with Ebstein's anomaly in pregnancy and anaesthesia are discussed.
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Prolonged anaesthesia with nitrous oxide inactivates vitamin B12 and impairs DNA synthesis in bone marrow cells. The use of parenteral folinic acid in the prevention of these toxic effects has been studied in 11 patients, ventilated artificially with nitrous oxide in oxygen for 24 h. ⋯ They were assessed morphologically and with the deoxyuridine suppression test. Folinic acid 30 mg immediately before anaesthesia and 30 mg 12 h later, prevented the toxic effects of nitrous oxide in four out of five patients, whereas smaller amounts of folinic acid (between 3 and 36 mg in 24 h), were ineffective.