Caudal S(+)-ketamine provides good intra- and postoperative analgesia in children. Despite similar plasma concentrations during most of the postoperative observation period, caudal S(+)-ketamine provided more effective analgesia than did intramuscular S(+)-ketamine, indicating a local analgesic effect.
The addition of clonidine to ropivacaine 0.75% does not lead to any advantage of block of the brachial plexus when compared with pure ropivacaine 0.75%.
Purpose: To evaluate the effects of clonidine on three local anesthetics (mepivacaine 1%, ropivacaine 0.75% and bupivacaine 0.5%) with comparable potency and almost the same concentration-response relationship.Methods: One hundred and twenty trauma-patients were randomly allocated into six groups. In the control-groups (Mo/Ro/Bo) brachial plexus was performed using 40 mL of local anesthetic plus 1 mL of NaCL 0.9%. In the clonidine-groups (Mc/Rc/Bc) brachial plexus was performed using each 40 mL of drug plus 1 mL (0.150 mg) of clonidine. Onset-time and the duration of the sensory block were recorded. Data are expressed as mean ± SD.Results: According to the average sensory block determined by a visual analog scale in the median, ulnar and radial nerve distributions and ranging from 100 (no sensory blockade) to 0 (complete sensory blockade), both mepi-groups showed a rapid onset (at 10 min: -Mo 20 ± 15 / Mc 19 ± 14; at 30 min: -Mo 3 ± 4 / Mc 5 ± 4). The ropi-and bupi-groups both had a longer onset time (at 10 min: -Ro 23 ± 19 / Rc 25 ± 22 / Bo 24 ± 15; at 30 min -Ro1 0 ± 6 / Rc11 ± 6 / Bo 12 ± 4). The onset time in group-Bc was significantly prolonged (at 10 min: -45 ± 21; at 30 min: -20 ± 6).
SummaryUntil recently, the most appropriate technique of intubating a patient with a cervical spine injury has been the subject of debate. Tracheal intubation by means of the intubating laryngeal mask (Fastrache), a modified conventional laryngeal mask airway, seems to require less neck manipulation. The aim of this study was to compare the excursion of the upper cervical spine during tracheal intubation using direct laryngoscopy with that during intubation via the laryngeal mask (Fastrache), by examination of lateral cervical spine radiographs in healthy young patients. The intubating laryngeal mask (Fastrache) caused less extension (at C 122 and C 223 ) than intubation by direct laryngoscopy. Direct laryngoscopy is still the fastest method to secure an airway provided no intubating difficulties are present. However, in trauma patients requiring rapid sequence induction and in whom cervical spine movement is limited or undesirable, the intubating laryngeal mask (Fastrache) is a safe and fast method by which to secure the airway.
All devices appeared to be safe airways. The Fastrach ILMA proved to be a reliable facilitator for blind intubation. CobraPLUS and Cookgas air-Q allowed an easy fibrescopic intubation. Failed blind intubations could not be predicted by the used parameters.
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