The effect of head and neck movement and Trendelenburg tilt on endotracheal tube position, relative to the carina, was studied in fifty adult patients requiring intubation for elective surgery. On average, inward movement, that is shortening of the distance between the endotracheal tube tip and the carina, resulted from neck flexion (mean =-5.5 mm), whereas outward movement occurred with neck extension (mean = 6.3 mm). Neck rotation, to right and left, and Trendelenburg tilt did not show any trend towards inward nor outward movement (mean = 0.3 mm/I.7 mm/-0.6 mm, respectively). Whilst these mean positional changes for flexion and extension confirm the findings of earlier investigations, our range of maximum inward and outward displacement for flexion (23 mm in/19 mm out), extension (21 mm in/33 mm out), rotation to right (19 mm in/17 mm out), to left (22 mm in/19 mm out) and Trendelenburg tilt (22 mm in/16 mm out) indicate that for any given postural change in anyone patient, the direction and magnitude of endotracheal tube displacement is not readily predictable.
The effectiveness of extradural injections of morphine sulphate 6 mg, methadone 6 mg, pethidine 60 mg and fentanyl 60 micrograms in relieving pain after operation were compared in 24 patients. The average duration of pain relief following morphine was 12.3 h; methadone 8.7 h, pethidine 6.6 h and fentanyl 5.7 h. There was no significant difference in the efficacy of the four drugs. There were no effects of clinical importance on heart rate, respiratory frequency or arterial pressure, but arterial systolic pressure decreased after morphine and pethidine. Pethidine also caused a statistically significant reduction in diastolic pressure.
Analgesia, following operation, was provided by the extradural administration of morphine or bupivacaine in 24 patients, in a double-blind, randomized, cross-over study. Observations were made of vital signs, peak expiratory flow rate (PEFR), quality and duration of pain relief and the occurrence of adverse effects. Vital signs were little affected by morphine, but hypotension requiring active treatment occurred in three patients following the administration of bupivacaine. The PEFR was improved about equally by each drug, and the improvement was significant compared with control values (P less than 0.001). Pain relief as judged by the linear analogue scale was significantly better following bupivacaine than after morphine (P less than 0.001), but the pain score system, while showing effective pain relief in most patients with both drugs, did not demonstrate a significant difference between them. The duration of effect of morphine was significantly longer (P less than 0.05) than that of bupivacaine. Adverse effects, other than bupivacaine-induced hypotension, were not serious.
Seventy patients undergoing haemorrhoidectomy under general anaesthesia were randomly allocated to one of five treatment groups in order to compare the effectiveness of various caudal agents in the control of postoperative pain. Four groups were given a caudal injection of either 2 % lignocaine, 0.5% bupivacaine, 2% lignocaine + morphine sulphate 4 mg or normal saline + morphine sulphate 4 mg, while the fifth (control) group did not receive an injection. The number of patients requiring postoperative opiates was significantly higher in the lignocaine group than in the morphine (p <0.05) and morphine-lignocaine (p <0.05) groups. No agent significantly reduced the number requiring opiates. In those who received opiates, the mean analgesic period was 228 minutes in the control group, and was significantly longer following bupivacaine (577 min, p <0.01), morphine-lignocaine (637 min, p <0.05) and morphine (665 min, p <0.01). The mean analgesic periodfol/owing lignocaine (349 min) was not significantly differentfrom control. The incidence of catheterisation was lowest in those patients who did not receive caudal analgesia.
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