Articles: anesthesia.
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J Bone Joint Surg Am · Jan 1985
Randomized Controlled Trial Clinical TrialThe use of epidural steroids in the treatment of lumbar radicular pain. A prospective, randomized, double-blind study.
Seventy-three patients with lumbar radicular pain syndromes were treated in a prospective, randomized, double-blind fashion with either seven milliliters of methylprednisolone acetate and procaine or seven milliliters of physiological saline solution and procaine. All patients had radiographic confirmation of lumbar nerve-root compression, consistent with the clinical diagnosis of either an acute herniated nucleus pulposus or spinal stenosis. ⋯ Long-term follow-up, averaging twenty months, failed to demonstrate the efficacy of a second injection of epidural steroids administered to the patients whose pain did not respond within twenty-four hours to an injection of either eighty milligrams of methylprednisolone acetate combined with five milliliters of 1 per cent procaine or two milliliters of sterile saline combined with five milliliters of 1 per cent procaine. Therefore, a decision to use epidural steroids must be made with the realization that we failed to demonstrate its clinical efficacy in this study and that reports of serious complications of this procedure have been published.
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Acta Obstet Gynecol Scand · Jan 1985
Randomized Controlled Trial Comparative Study Clinical TrialAnalgesia and maternal side effects of pudendal block at delivery. A comparison of three local anesthetics.
In a randomized double-blind study, 1048 women received pudendal block (PDB) at vaginal delivery, using three different local anesthetics: mepivacaine 1% plain, mepivacaine 1% with epinephrine, and bupivacaine 0.25% plain. The PDB was given transvaginally in doses of 8 ml X 2. Mepivacaine - epinephrine was found to be more effective than the other local anesthetics. ⋯ Inhibition of labor was slightly more pronounced with mepivacaine - epinephrine. The different durations of the local anesthetics did not affect the analgetic effect in clinical use. It is concluded that as the adverse effects on labor are quite common, PDB should not be given as a routine before delivery, but may be offered liberally when pain in the pudendal area is a main part of the pain of childbirth.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of methohexitone and propofol ('Diprivan') for induction of enflurane anaesthesia in outpatients.
In 73 unpremedicated patients scheduled for minor outpatient oral surgery or restorative dentistry, enflurane anaesthesia was induced either with an emulsion formulation of propofol (2.5 mg/kg) or with methohexitone (2 mg/kg). Sensations at the site of the injection were more common when the drugs were injected into a vein in the dorsum of the hand (58% for propofol and 28% for methohexitone) when compared to a vein in the forearm or antecubital area (7 to 8% with sensations). After induction of anaesthesia intravenous suxamethonium was given, and endotracheal intubation carried out. ⋯ The incidence of nausea or vomiting was similar (27 to 33%) in both groups. It is concluded that both propofol in emulsion form and methohexitone are satisfactory induction agents in outpatient dentistry. Propofol provided a smoother induction of anaesthesia and recovery was as rapid as after anaesthesia induced with methohexitone.
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Randomized Controlled Trial Clinical Trial
A study of the use of ultrasonically nebulized lignocaine for local anaesthesia during fibreoptic bronchoscopy.
The use of nebulized lignocaine, with and without intravenous diazepam premedication, was compared with lignocaine given by bolus in 52 patients undergoing fibreoptic bronchoscopy (FOB). Changes in airflow, cardiac rhythm, and transcutaneous PO2 were recorded, and patient acceptability, blood lignocaine levels, and the duration of the procedure were also monitored. ⋯ Nebulized lignocaine without diazepam was acceptable to the patients and was not associated with the significant (P less than 0.03) falls in transcutaneous PO2 which followed diazepam administration. Nebulized lignocaine, with and without, diazepam premedication is a safe, effective and acceptable method of inducing topical anaesthesia for FOB.
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Acta Anaesthesiol Scand · Jan 1985
Randomized Controlled Trial Comparative Study Clinical TrialEffects of three anaesthesia methods on haemodynamic responses connected with the use of thigh tourniquet in orthopaedic patients.
Haemodynamic changes were studied in 51 patients undergoing orthopaedic surgery of the lower extremity, including exsanguination and thigh tourniquet for longer than 60 min. The patients were randomly divided into three anaesthesia groups: general anaesthesia (including enflurane), epidural anaesthesia (20 ml 0.5% bupivacaine) and spinal anaesthesia (3 ml 0.5% bupivacaine). During the study, five epidural and one spinal patient excluded from haemodynamic comparison required general anaesthesia because of pain from the surgery or ischaemia. ⋯ On the other hand, 11/15 of the epidural patients needed additional analgesics and/or sedation for pain or restlessness. The mean rise in the haemodynamic parameters including CVP was small on inflation of the tourniquet cuff; on deflation there was a mean decrease in CVP of 1-3 cmH2 (0.1-0.3 kPa), the maximum decrease being 8 cmH2O (0.8 kPa). The mean decrease in systolic arterial blood pressure ranged from 2 to 14 mmHg (0.27 to 1.87 kPa) when the cuff was deflated.