Articles: anesthesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Anaesthesia for evacuation of retained products of conception. Comparison between alfentanil plus etomidate and fentanyl plus thiopentone.
Forty-four patients presenting for evacuation of retained products of conception were anaesthetized with either fentanyl and thiopentone, or alfentanil with etomidate, along with 70% nitrous oxide in oxygen. There was no difference between the two techniques in indices of immediate recovery (time to opening eyes and obeying a simple command), but the rate of return of higher mental functions (assessed by a coin counting test) was significantly better using the alfentanil-etomidate technique. There was no statistically significant difference between the techniques for apnoea or abnormal movements during anaesthesia, but alfentanil with etomidate was associated with significantly more pain on injection and a higher frequency of postoperative vomiting (40%).
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Randomized Controlled Trial Clinical Trial
Effect of posture during the induction of subarachnoid analgesia for caesarean section. Right v. left lateral.
Thirty-five women scheduled for elective Caesarean section were randomly assigned to have subarachnoid analgesia induced in either the right or left lateral position. They were then turned supine with a wedge under the right hip. No patient in the right-sided group required further analgesia. Five patients in the left-sided group required postural manipulation to encourage the spread of analgesia and two required supplementary analgesia (P less than 0.01).
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Randomized Controlled Trial Comparative Study Clinical Trial
Effect of gravity on the spread of extradural anaesthesia for caesarean section.
The effect of gravity on the spread of extradural anaesthesia was evaluated in a series of parturients undergoing elective Caesarean section. Following placement of an extradural catheter, 25 patients were placed 30-40 degrees head-up for 20 min during the administration of the local anaesthetic drug; 25 additional patients remained supine during injection. ⋯ There were no differences in the rate of onset of sacral blockade or in the extent of neural blockade between the two groups. The semi-upright position was not necessary to ensure adequate sacral anaesthesia for Caesarean section.
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Randomized Controlled Trial Clinical Trial
Postoperative headache in young patients after spinal anaesthesia.
Spinal anaesthesia was performed on 247 young adult patients with a 25-G needle. Rectal administration of indomethacin had no significant effect on the incidence of postdural puncture headache, which occurred in 16.8% of patients who received the drug compared to 24.5% who received a placebo. A history of headache pre-operatively did not influence the incidence of postlumbar puncture headache.
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Randomized Controlled Trial Comparative Study Clinical Trial
Randomised trial of fentanyl anaesthesia in preterm babies undergoing surgery: effects on the stress response.
In a randomised controlled trial, preterm babies undergoing ligation of a patent ductus arteriosus were given nitrous oxide and d-tubocurarine, with (n = 8) or without (n = 8) the addition of fentanyl (10 micrograms/kg intravenously) to the anaesthetic regimen. Major hormonal responses to surgery, as indicated by changes in plasma adrenaline, noradrenaline, glucagon, aldosterone, corticosterone, 11-deoxycorticosterone, and 11-deoxycortisol levels, in the insulin/glucagon, molar ratio, and in blood glucose, lactate, and pyruvate concentrations were significantly greater in the non-fentanyl than in the fentanyl group. ⋯ Compared with the fentanyl group, the non-fentanyl group had circulatory and metabolic complications postoperatively. The findings indicate that preterm babies mount a substantial stress response to surgery under anaesthesia with nitrous oxide and curare and that prevention of this response by fentanyl anaesthesia may be associated with an improved postoperative outcome.