Anaesthesia and intensive care
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Anaesth Intensive Care · Oct 1994
Alterations in endotracheal tube position during general anaesthesia.
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/1.7 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 any one patient, the direction and magnitude of endotracheal tube displacement is not readily predictable.
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Anaesth Intensive Care · Oct 1994
Randomized Controlled Trial Comparative Study Clinical TrialHigh-dose aprotinin in cardiac surgery--a prospective, randomized study.
Fifty patients undergoing primary coronary artery bypass surgery and 50 patients undergoing valve surgery received either high-dose aprotinin (2 million units loading dose, 2 million units added to the CPB prime, and 500,000 units/hr maintenance infusion) or placebo. Mean postoperative blood loss in the first six hours was reduced from 321 ml in the placebo group to 172 ml in the aprotinin group (95% confidence interval (CI) for difference = 95 to 189 ml). Seven patients in the placebo group and 16 patients in the aprotinin group did not require transfusion with homologous blood. This study adds to the growing body of evidence that the administration of high-dose aprotinin reduces blood loss and blood transfusion requirements associated with primary cardiac surgery.
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Anaesth Intensive Care · Oct 1994
Randomized Controlled Trial Comparative Study Clinical TrialPropofol injection pain: comparing the addition of lignocaine or metoclopramide.
Lignocaine has been shown to reduce the incidence of pain on injection of propofol. Metoclopramide, a weak local anaesthetic and commonly used antiemetic, was combined with propofol and the mixture compared, in a prospective, randomized trial, with a lignocaine-propofol combination. ⋯ One patient in the metoclopramide-propofol group had a minor extrapyramidal reaction. No adverse local or haemodynamic effects were seen.
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Anaesth Intensive Care · Oct 1994
Randomized Controlled Trial Comparative Study Clinical TrialOndansetron for prevention of postoperative nausea and vomiting following minor oral surgery: a double-blind randomized study.
The efficacy and safety of ondansetron in preventing postoperative nausea and vomiting following minor oral surgery was evaluated in a prospective randomized double-blind study. Of a total of seventy-seven patients, randomly 38 had 4 mg of ondansetron and 39 had normal saline as placebo intravenously immediately prior to induction of anaesthesia. A standard general anaesthetic with thiopentone, suxamethonium, fentanyl, nitrous oxide and isoflurane was employed. ⋯ Patients who vomited twice or more and the number who required a rescue antiemetic were significantly fewer in the ondansetron group (P < 0.05). Cardiovascular parameters were stable and showed no significant difference in the two groups. There were no significant adverse effects that could be directly attributable to ondansetron.