Articles: anesthesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Effects of different glucose concentrations on spinal anaesthesia with bupivacaine and tetracaine.
The effects of 5% and 8% glucose in 0.5% tetracaine or bupivacaine on the anaesthetic spread were investigated in 80 urological patients requiring spinal anaesthesia for trans-urethral resection of the prostate. The local anaesthetic solutions were randomly administered, the patients being divided into four groups of 20, and the anaesthetic profile was then evaluated in a double-blind fashion by an independent observer. Maximum cephalad spread of analgesia was significantly greater with tetracaine in 8% glucose compared to the other three groups (tetracaine/5% glucose, bupivacaine/5 or 8% glucose) (P less than 0.05). ⋯ Both the 5% and 8% solutions of tetracaine achieved a 3+ motor blockade significantly faster than either bupivacaine solution. Regression of motor blockade from tetracaine was not influenced by the glucose concentration, but the 8% solution of bupivacaine had a delayed 2+ and 3+ blockade, although the ultimate decay for both solutions was similar. The results of our study suggest that 0.5% bupivacaine 4 ml in 5% glucose provides a rapid and controllable spread of sensory analgesia for transurethral surgery, of optimal duration associated with a complete motor blockade of moderate duration.
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Acta Anaesthesiol Scand · May 1989
Randomized Controlled Trial Comparative Study Clinical TrialIntravenous regional analgesia--a new modification.
A modification of the standard intravenous regional analgesia technique is described whereby excess local anaesthetic solution is removed from the veins of the isolated arm once analgesia has been established. This simple procedure was shown to reduce the incidence of oozing at the site of operation without affecting the quality of analgesia. Measurement of the quantity of local anaesthetic agent removed from the isolated arm 15 min after injection revealed that the amounts removed were small, indicating rapid uptake and binding in the tissues. This would imply that removal of excess local anaesthetic agent from the isolated arm after 15 min does not confer added safety as regards reducing the risk of leakage of agent into the general circulation in the event of cuff failure.
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Acta Anaesthesiol Scand · May 1989
Randomized Controlled Trial Comparative Study Clinical TrialSpontaneous recovery of residual neuromuscular blockade after atracurium or vecuronium during isoflurane anaesthesia.
With atracurium and vecuronium, spontaneous recovery of residual neuromuscular blockade monitored electromyographically during 0.5% isoflurane anaesthesia was studied in 60 patients undergoing plastic surgery. After thiopentone, in random order, either atracurium 0.5 mg kg-1 or vecuronium 0.1 mg kg-1 was administered and isoflurane added to N2O and O2 mixture. Following spontaneous recovery of both the single twitch amplitude (T1) to 75% of the control value and the train-of-four ratio (TOF ratio) to 75%, incremental doses of the relaxant were given to maintain the T1 at less than 10%. ⋯ The recovery time from T1 75% to TOF ratio 75%, indicating the recovery rate of residual neuromuscular blockade, with atracurium was about 15 min after both the initial and the second recoveries. With vecuronium, the respective recovery times were significantly (P less than 0.001) longer (25.6 min and 38.5 min, respectively). It is concluded that with vecuronium there is slower spontaneous recovery of residual neuromuscular blockade than with atracurium.
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Anaesth Intensive Care · May 1989
Randomized Controlled Trial Clinical TrialEpidural morphine by the thoracic or lumbar routes in cholecystectomy. Effect on postoperative pain and respiratory variables.
Thirty-seven women undergoing elective cholecystectomy were randomised into two groups, receiving either lumbar epidural morphine (group L) or epidural morphine via the thoracic route (group T). The effect on pain relief was assessed by a visual analogue scale and included both resting pain and 'provoked' pain. ⋯ No significant difference was observed between the groups concerning pain relief or respiratory performance. We conclude that after cholecystectomy lumbar epidural morphine is as effective as thoracic epidural morphine in relieving postoperative pain.
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Randomized Controlled Trial Clinical Trial
Epidural diamorphine and bupivacaine in labour.
A double-blind randomised study was performed to assess the analgesic effect of epidural diamorphine, administered with bupivacaine, on primigravid women in labour. Fifty patients received 0.25% bupivacaine 10 ml via the epidural catheter as their initial dose; patients in Group 1 received diamorphine 5 mg with the bupivacaine. A 0.1% bupivacaine infusion was started at 10 minutes and bolus doses of bupivacaine were given if required. There was a significant reduction in rate of bupivacaine administration, pain scores at 20 and 30 minutes, number of supplements required, and degree of motor blockade in the diamorphine group.