British journal of anaesthesia
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An extradural catheter was inserted at the third lumbar interspace for relief of pain during labour in a 21-year-old gravid patient. Attempts to withdraw the catheter met with resistance and produced severe pain in the distribution of the second left lumbar nerve. Radiography revealed an acutely angled loop of the catheter over the L2-3 nerve root.
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The pattern of ventilation was studied in eight healthy male volunteers breathing, in sequence, air and then two subanaesthetic concentrations of nitrous oxide (20% and 40%). The effect of these gas mixtures on the response to an added inspiratory resistance (3.88 kPa litre-1s-1) was examined. During unrestricted breathing of 40% nitrous oxide, there was a significant decrease (P less than 0.05) in inspiratory time (TI), a concomitant increase in the rate of ventilation and a significant decrease (P less than 0.05) in the end-tidal carbon dioxide tension (PE'CO2) compared with air breathing. ⋯ TI, VT, minute volume and PE'CO2 were similar for each gas mixture during steady state breathing against resistance. The increase in PE'CO2 when breathing 40% nitrous oxide against the resistance represented a significant (P less than 0.01) difference in response to the load compared with that breathing air. There was no significant change in these variables when breathing 20% nitrous oxide.
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Randomized Controlled Trial Comparative Study Clinical Trial
Psychomimetic reactions after low-dose ketamine infusion. Comparison with neuroleptanaesthesia.
Low-dose ketamine anaesthesia was compared with neuroleptanaesthesia, in respect of immediate and longer-term psychomimetic reactions, in 40 female patients undergoing elective gynaecological surgery. Qualitatively, but not quantitatively, different psychomimetic reactions occurred in both groups. ⋯ Interviews after 3 months revealed a low frequency of psychomimetic reactions in both groups. However, 30% of all the patients (12) complained of impairment of intellectual function, and in seven patients this was severe enough to interfere with their ability to work.
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Randomized Controlled Trial Comparative Study Clinical Trial
Sedation for fibreoptic gastroscopy: a comparative study of midazolam and diazepam.
Midazolam, a water-soluble benzodiazepine, was compared with diazepam in fat emulsion (Diazemuls) as sedation for outpatient gastroscopy in a randomized double-blind fashion. Midazolam 0.05 mg kg-1 was found to be approximately equipotent to Diazemuls 0.15 mg kg-1. There were no differences concerning speed of recovery and all patients were considered ready for discharge after 2 h. ⋯ With the same degree of sedation, midazolam produced a higher frequency of amnesia (60% v. 7%; P less than 0.001) for the endoscopic procedure. Although the patients appeared to prefer midazolam to Diazemuls, this difference was significant only in patients who had not previously undergone gastroscopy (P less than 0.05). The high degree of amnesia with midazolam may be an advantage in sedation for unpleasant procedures like gastroscopy.