ABSTRACT
We have studied the efficacy of two extradural infusions (10 ml h-1) in 50 patients in active labour. Patients in the diamorphine group (n = 25) received 0.0625% plain bupivacaine 6.25 mg h-1 mixed with 0.005% diamorphine 0.5 mg h-1 and those in the control group (n = 25) received 0.125% plain bupivacaine 12.5 mg h-1. Both groups received intermittent "top-ups" of 0.25% bupivacaine 10 ml when indicated. Although median pain scores during the infusion were similar in both groups, patients in the diamorphine group indicated greater satisfaction with the infusion (88% very satisfied, compared with 52% in the control group (P < 0.02)). There were no differences in the incidence of hypotension, instrumental vaginal delivery, number of "top-ups", duration of the second stage or extent of motor block. However, patients in the diamorphine group had a high incidence of pruritus (44%, compared with 0% in the control group (P < 0.01)).
Subject(s)
Analgesia, Epidural , Analgesia, Obstetrical , Bupivacaine , Heroin , Adolescent , Adult , Delivery, Obstetric , Double-Blind Method , Drug Combinations , Female , Heroin/adverse effects , Humans , Pain Measurement/drug effects , Pregnancy , Pruritus/chemically inducedABSTRACT
Seventy-three women who requested epidural analgesia during labour were randomly allocated in a prospective study to receive either a continuous epidural infusion of 0.075% bupivacaine at a rate of 12-18 ml/hour (38 mothers) or intermittent top-ups of 0.5% bupivacaine (35 mothers). Both groups received an initial dose of 6-8 ml bupivacaine 0.5%. Patients were asked to score their pain using a 10-cm linear scale prior to insertion of the epidural, 30 minutes after its insertion and hourly thereafter. The quality of analgesia in the continuous infusion group was significantly better than in the intermittent top-up group (p less than 0.025). There was no significant difference in the total dose of bupivacaine given to the two groups.
Subject(s)
Anesthesia, Epidural , Anesthesia, Obstetrical , Bupivacaine/administration & dosage , Labor, Obstetric , Adolescent , Adult , Delivery, Obstetric , Female , Humans , Infusions, Parenteral , Motor Neurons , Nerve Block , Pain Measurement , Pregnancy , Prospective StudiesABSTRACT
A case of acquired C1 esterase inhibitor deficiency and its anaesthetic implications is presented. Prophylaxis against angioneurotic oedema using danazol and tranexamic acid is described and the resultant complication of mesenteric venous thrombosis reported.
Subject(s)
Angioedema/etiology , Complement C1 Inactivator Proteins/deficiency , Female , Humans , Mesenteric Vascular Occlusion/etiology , Middle Aged , Postoperative Complications/etiology , Thrombosis/etiology , Tranexamic Acid/adverse effectsABSTRACT
Indoramin, a competitive alpha 1-adrenoceptor antagonist, was administered intravenously to 12 fit patients aged 20-49 years during general anaesthesia with either halothane or enflurane for ear, nose and throat surgery. A mean decrease of systolic blood pressure of 6 mmHg followed the initial dose of 0.1 mg/kg. Systolic blood pressures of 70-80 mmHg were achieved in nine patients using 0.29-4 mg/kg. The maximum effect of every dose was achieved within 3 minutes, with a probable duration of action of at least 30 minutes. Large changes of heart rate did not occur, though there was gradual slowing of the heart during each series of incremental administrations. Junctional rhythm, sometimes with bradycardia and hypotension, occurred in five patients (four in halothane group; one in enflurane group). Because of this, and the greater than ten-fold variation in decrease of blood pressure for a single weight-related dose, indoramin is not recommended for the reduction of blood pressure during halothane anaesthesia.
Subject(s)
Hypotension, Controlled , Indoles , Indoramin , Otorhinolaryngologic Diseases/surgery , Adult , Anesthesia, Inhalation , Blood Pressure/drug effects , Enflurane , Female , Halothane , Heart Rate/drug effects , Humans , Indoles/pharmacology , Indoramin/pharmacology , Male , Middle Aged , Time FactorsABSTRACT
Fifty-one inpatients and 58 outpatients undergoing elective gynaecological laparoscopy under general anaesthesia were investigated for post-operation morbidity by means of questionnaires. A high incidence of morbidity was found in both groups extending into the second day, with no marked difference between the two groups.
Subject(s)
Ambulatory Care , Laparoscopy/adverse effects , Analgesics/therapeutic use , Antiemetics/therapeutic use , Female , Humans , Pain/drug therapy , Pain/etiology , Premedication , Time Factors , Vomiting/drug therapy , Vomiting/etiologyABSTRACT
The effect of changes in muscle blood flow on the rate of recovery from neuromuscular block produced by pancuronium was investigated in dogs, and were shown to be independent variables. The significance of this finding in relation to recent work on blood concentrations of the drug and on the pharmacodynamics of the drug is discussed.
Subject(s)
Muscles/blood supply , Neuromuscular Junction/drug effects , Pancuronium/pharmacology , Animals , Dogs , Hindlimb , Time FactorsABSTRACT
The TM3 Gas differentiator, a simple device introduced to differentiate between nitrous oxide and oxygen, was found to be capable of positively distinguishing between these gases when only they were known to be present. The differentiator gave nearly equal responses to nitrous oxide and carbon dioxide. Cyclopropane, halothane, methoxyflurane, trichloroethylene and nitrogen all produced smaller responses on the differentiator's built-in meter. This apparatus has proved in use to be a practicable and simple method of checking the composition of gases emerging from pipelines.
