Abstract:
:Spinal anaesthesia is the preferred anaesthetic technique for elective Caesarean deliveries. Hypotension is the most common side-effect and has both maternal and neonatal consequences. Different strategies have been attempted to prevent spinal-induced hypotension, including the use of low-dose bupivacaine. We conducted a systematic search for randomized controlled trials comparing the efficacy of spinal bupivacaine in low dose (LD ≤8 mg) with conventional dose (CD >8 mg) for elective Caesarean delivery. Thirty-five trials were identified for eligibility assessment, 15 were selected for data extraction, and 12 were finally included in the meta-analysis. We investigated sources of heterogeneity, subgroup analysis, and meta-regression for confounding variables (baricity, intrathecal opioids, lateral vs sitting position, uterine exteriorization, and study population). Sensitivity analysis was performed to test the robustness of the results. In the LD group, the need for analgesic supplementation during surgery was significantly higher [risk ratio (RR)=3.76, 95% confidence interval (95% CI)=2.38-5.92] and the number needed to treat for an additional harmful outcome (NNTH) was 4 (95% CI=2-7). Furthermore, the LD group exhibited a lower risk of hypotension (RR=0.78, 95% CI=0.65-0.93) and nausea/vomiting (RR=0.71, 95% CI=0.55-0.93). Conversion to general anaesthesia occurred only in the LD group (two events). Neonatal outcomes (Apgar score, acid-base status) and clinical quality variables (patient satisfaction, surgical conditions) showed non-significant differences between LD and CD. This meta-analysis demonstrates that low-dose bupivacaine in spinal anaesthesia compromises anaesthetic efficacy (risk of analgesic supplementation: high grade of evidence), despite the benefit of lower maternal side-effects (hypotension, nausea/vomiting: moderate grade of evidence).
journal_name
Br J Anaesthjournal_title
British journal of anaesthesiaauthors
Arzola C,Wieczorek PMdoi
10.1093/bja/aer200subject
Has Abstractpub_date
2011-09-01 00:00:00pages
308-18issue
3eissn
0007-0912issn
1471-6771pii
S0007-0912(17)33114-8journal_volume
107pub_type
杂志文章,meta分析,评审abstract:BACKGROUND:Miller laryngoscope blades are preferred for laryngoscopy in infants and children <2 yr of age. Despite their long history, the laryngeal view with the Miller blade size 1 has never been compared with that with the Macintosh (MAC) blade in children. This prospective, single-blinded, randomized study was desi...
journal_title:British journal of anaesthesia
pub_type: 杂志文章,随机对照试验
doi:10.1093/bja/aeu228
更新日期:2014-11-01 00:00:00
abstract:BACKGROUND:The aim of this study is to test the hypothesis that a standard 30-min break in a routine 7.5 h period of work makes a difference in cognitive function. METHODS:In a double-blinded, cross-over trial 30 residents in anaesthesia were randomized to receive or not to receive a 30-min break between the assessmen...
journal_title:British journal of anaesthesia
pub_type: 杂志文章,随机对照试验
doi:10.1093/bja/ael151
更新日期:2006-09-01 00:00:00
abstract::Bioactive substances in fresh frozen plasma (FFP) are considered to be related to adverse reactions after transfusion, particularly in septic or traumatized patients. Therefore, we analysed the concentration of various bioactive substances (histamine, eosinophil cationic protein, eosinophil protein X, myeloperoxidase ...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/78.5.548
更新日期:1997-05-01 00:00:00
abstract:BACKGROUND:General anaesthesia is a balance between hypnosis and analgesia. We investigated whether an increase in remifentanil blood concentration would reduce the amount of propofol required to maintain a comparable level of anaesthesia in 60 patients undergoing ambulatory surgery. METHODS:Patients were allocated ra...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1093/bja/aeg115
更新日期:2003-05-01 00:00:00
abstract:BACKGROUND:Robotic-assisted laparoscopic radical prostatectomy (RALRP) is gaining popularity as a less traumatic and minimally invasive alternative to open radical retropubic prostatectomy (RRP). The aim of this study was to evaluate the incidence and grade of venous gas embolism (VGE) during RALRP compared with those ...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/aeq247
更新日期:2010-12-01 00:00:00
abstract:BACKGROUND:The cuff pressures may be different in oesophageal and tracheal intubations. We conducted a study to evaluate if cuff pressures of endotracheal tubes (ETTs) could provide information to distinguish tracheal or oesophageal intubations in a pig trachea-oesophagus model. METHODS:In each preparation of pig trac...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/aem244
更新日期:2007-11-01 00:00:00
abstract:BACKGROUND:High-dose glucocorticoid may reduce postsurgical pain and improve recovery. We hypothesized that 125 mg methylprednisolone (MP) would reduce time to meet functional discharge criteria after total hip arthroplasty (THA). METHODS:Forty-eight patients undergoing unilateral THA under spinal anaesthesia were con...
journal_title:British journal of anaesthesia
pub_type: 杂志文章,随机对照试验
doi:10.1093/bja/aes345
更新日期:2013-01-01 00:00:00
abstract::The calculation of pharmacokinetic parameters after a bolus injection of fentanyl allowed an i.v. infusion scheme which guarantees analgesia for the entire duration of surgery, with the advantage of steady plasma concentration and body content. In the initial phase after bolus injection, the serum concentration decrea...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/52.10.1021
更新日期:1980-10-01 00:00:00
abstract::We have studied 13 patients with diabetic nephropathy and 13 patients with uraemia of other origin undergoing renal transplantation, and 12 control patients undergoing general surgery. QTc dispersion and maximum QTc interval were calculated from the 12-lead ECG, and cardiovascular autonomic function tests were perform...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/73.6.801
更新日期:1994-12-01 00:00:00
abstract::We report a case of lumbar extradural abscess that presented 9 days after an elective Caesarean section performed under combined spinal-extradural anaesthesia. This was successfully treated conservatively with full recovery. The clinical course included development, and then resolution, of mild paraparesis. Conservati...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/78.5.591
更新日期:1997-05-01 00:00:00
abstract::We studied psychomotor performance in 10 healthy volunteers during recovery after a target-controlled infusion of propofol. Choice reaction time, dual task tracking with secondary reaction time and a within-list recognition task were assessed at target blood propofol concentrations of 0.8, 0.4 and 0.2 microgram ml-1. ...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/85.3.396
更新日期:2000-09-01 00:00:00
abstract::We have undertaken a prospective, randomized study to determine the incidence of postoperative nausea and vomiting during intensive care stay after cardiac surgery, and to study the effect of addition of droperidol to an infusion of morphine used for postoperative analgesia. Data from 398 patients were examined. The u...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1093/bja/77.3.356
更新日期:1996-09-01 00:00:00
abstract::In a prospective study, patients undergoing abdominal surgery were allocated randomly to receive intermittent morphine 10 mg i.m. (n = 41) or a single injection of buprenorphine 0.3 mg i.m. followed by sublingual buprenorphine 0.4 mg every 6 h (n = 39) for 3 days following operation. Patients receiving buprenorphine w...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1093/bja/56.8.855
更新日期:1984-08-01 00:00:00
abstract::The possibility of an interaction between diazepam and pancuronium bromide was investigated in six patients undergoing general anaesthesia maintained with fentanyl, droperidol and nitrous oxide. Neuromuscular blockade was controlled using a feedback mechanism which automatically adjusted the rate of injection of pancu...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/53.8.859
更新日期:1981-08-01 00:00:00
abstract::We have investigated the effect of interpleural morphine on postoperative pain and pulmonary function after thoracotomy. At the end of surgery, an interpleural catheter was inserted in 17 patients and, in a double-blind and randomized manner, either a bolus of morphine 2.5 mg interpleurally (i.p.) and normal saline i....
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1093/bja/69.6.637
更新日期:1992-12-01 00:00:00
abstract::Intragastric pressure was measured in 20 patients before, and immediately after, the induction of anaesthesia with thiopentone. Intragastric pressure decreased in patients whose weights were the same as or less than expected, and increased in five of seven patients whose weights were greater than expected (P = 0.0013)...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/56.8.873
更新日期:1984-08-01 00:00:00
abstract::The effect on intervillous blood flow of lumbar extradural analgesia for Caesarean section was studied in nine healthy women using xenon-133. Extradural anaesthesia was performed with lignocaine 1 1/2% 16--20 ml with adrenaline 5 microgram ml-1. Impairment of placental blood flow during the block was observed in seven...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/50.3.275
更新日期:1978-03-01 00:00:00
abstract::The coherent frequency (CF) of the auditory evoked response (AER) is derived using auditory clicks presented at frequencies in the range 5-47 Hz. CF and psychological performance were measured while seven subjects breathed isoflurane in doses increasing from 0% to 0.2%, 0.4% and 0.8% end-tidal concentration and then d...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/71.5.633
更新日期:1993-11-01 00:00:00
abstract::Procaine has been advocated in the treatment of malignant hyperpyrexia, whereas lignocaine has been shown to worsen the condition. Using muscle from patients susceptible to malignant hyperpyrexia in vitro, it has been demonstrated that muscle contracture can occur with procaine on its own, and in one patient the halot...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/47.1.17
更新日期:1975-01-01 00:00:00
abstract::The effect of diluting propofol in 5% dextrose on the incidence of i.v. injection pain was studied in 100 adult patients. Severe injection pain occurred in 32% (16 patients) who received undiluted propofol, compared with 10% (five patients) who received dilute propofol. We concluded that the dilution of propofol signi...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1093/bja/62.2.202
更新日期:1989-02-01 00:00:00
abstract::Infusion thrombophlebitis is a common complication of i.v. infusions. Many factors appear to be involved in its aetiology, of which the duration of infusion, the drugs infused and the solution(s) infused are the most important. Effective prophylaxis should be based on an understanding of the possible pathophysiology. ...
journal_title:British journal of anaesthesia
pub_type: 杂志文章,评审
doi:10.1093/bja/57.2.220
更新日期:1985-02-01 00:00:00
abstract::We have evaluated the effect of delivering nitric oxide using a continuous flow system (CFS) or two commercially available proportional gas injection systems (PGIS), Nodomo (Dräger, Lübeck, Germany) and Pulmonox-Mini (Messer Griesheim Austria, Gumpoldskirchen, Austria) on measured and simulated concentrations of nitri...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/81.4.544
更新日期:1998-10-01 00:00:00
abstract::The effect of the i.v. administration of methylene blue dye on haemoglobin oxygen saturation, measured by a pulse oximeter was investigated. The absorption spectra of various concentrations of haemoglobin, oxyhaemoglobin and methylene blue were compared. The amount of 660-nm light absorbed by methylene blue was suffic...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/60.4.439
更新日期:1988-03-01 00:00:00
abstract:INTRODUCTION:Compared with term neonates, preterm babies are more likely to die from sepsis. However, the combined effects of sepsis and prematurity on neonatal postoperative mortality are largely unknown. Our objective was to quantify the proportion of neonatal postoperative mortality that is attributable to the syner...
journal_title:British journal of anaesthesia
pub_type: 杂志文章,多中心研究
doi:10.1016/j.bja.2020.07.026
更新日期:2020-12-01 00:00:00
abstract:BACKGROUND:Magnesium is a calcium and an NMDA-receptor antagonist and can modify important mechanisms of nociception. We evaluated the co-analgesic effect of magnesium in the postoperative setting after on-pump cardiac surgery. METHODS:Forty patients randomly received either magnesium gluconate as an i.v. bolus of 0.2...
journal_title:British journal of anaesthesia
pub_type: 杂志文章,随机对照试验
doi:10.1093/bja/ael037
更新日期:2006-04-01 00:00:00
abstract::The effects of Org NC 45 and pancuronium bromide on heart rate and arterial pressure were studied in anaesthetized man. A bolus of either Org NC 45 0.1 mg kg-1 or pancuronium 0.1 mg kg-1 was administered to lightly anaesthetized unstimulated subjects. Following Org NC 45 heart rate decreased in the majority of subject...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/54.4.435
更新日期:1982-04-01 00:00:00
abstract::The time course of the plasma lignocaine concentration, following caudal anaesthesia, was studied in 11 healthy children (3.5-9 yr). Plasma lignocaine concentrations were measured for up to 6 h after administration (5 mg kg-1). Peak plasma concentration was 2.05 +/- 0.08 micrograms ml-1 and occurred at 28.2 +/- 2.9 mi...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/56.12.1399
更新日期:1984-12-01 00:00:00
abstract::We have compared bispectral index (BIS), 95% spectral edge frequency (SEF) and approximate entropy (ApEn) in 37 patients during induction and recovery from a short general anaesthetic. Heart rate variability (HRV) was also compared during induction only. These indices were noted at the start of induction, when a syrin...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章
doi:10.1093/bja/82.5.666
更新日期:1999-05-01 00:00:00
abstract::In the prone knee-chest position the spread of plain 0.5% bupivacaine in the cerebrospinal fluid and associated haemodynamic changes may be different compared with the horizontal position. A randomized comparison was performed in 40 ASA I-II patients, aged 24-61 yr, undergoing lumbar disc surgery. Subarachnoid injecti...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1093/bja/79.5.609
更新日期:1997-11-01 00:00:00
abstract:BACKGROUND:We used an automated bispectral index (BIS)-guided dual-loop controller to determine propofol and remifentanil requirements during general anaesthesia in obese and lean surgical patients. METHODS:Obese patients, BMI>35 kg m(-2), and lean patients (<25 kg m(-2)) having laparoscopic procedures were prospectiv...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章,多中心研究
doi:10.1093/bja/aeu401
更新日期:2015-04-01 00:00:00