European journal of anaesthesiology
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Tracheostomy is necessary in intensive care unit (ICU) patients requiring prolonged mechanical ventilation. As an alternative to the standard surgical method, percutaneous techniques are available. Seventy-two patients were electively selected for percutaneous tracheostomy (PCT) in a nine-bed combined medical-surgical intensive care unit. ⋯ In one patient, minor bleeding occurred at the stoma site that resolved with applied pressure. Wound infections were treated with local antiseptics in two patients. These findings suggest that PCT is a simple, quick and safe procedure.
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Randomized Controlled Trial Comparative Study Clinical Trial
Epidural fentanyl-bupivacaine compared with clonidine-bupivacaine for analgesia in labour.
Alpha-adrenergic agonists produce pain relief through an opioid independent mechanism and may be alternatives to opioids for combination with local anaesthetics for analgesia during labour. We studied 41 pregnant women. Epidural block was performed with 75 microg clonidine (n = 20) or 50 microg fentanyl (n = 21) combined with 0.125% bupivacaine (10 mL). ⋯ Analgesia lasted longer in the bupivacaine-clonidine group (139.4 +/- 31 min) compared with the bupivacaine-fentanyl group (127.9 +/- 48 min) (P = 0.42). Additional analgesic requirement was more often in the fentanyl-bupivacaine group and total bupivacaine requirement was less in the clonidine-bupivacaine group (22.5 +/- 12.5 mg vs. 30.9 +/- 12.8 mg) (P = 0.04). This small study confirms that this combination of bupivacaine and clonidine provides satisfactory analgesia for first-stage labour, and of longer duration than bupivacaine-fentanyl.
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Letter Case Reports
A successfully resuscitated case of amniotic fluid embolism.
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Case Reports
Airway obstruction during general anaesthesia in a child with congenital tracheomalacia.
Fibreoptic bronchoscopy is often used to diagnose tracheomalacia under local anaesthesia. However, in children, general anaesthesia may be required due to difficulty in obtaining co-operation. A 1-yr-old girl with a suspected congenital tracheomalacia was scheduled for diagnostic fibreoptic bronchoscopy. ⋯ No further airway obstruction occurred during fibrescopy under controlled ventilation, but when spontaneous breathing resumed, marked airway obstruction occurred. The trachea was intubated immediately. Caution is required to manage the airway without tracheal intubation during general anaesthesia in the patient with tracheomalacia.