Anaesthesia and intensive care
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Anaesthetists work as part of a process and deal with complex situations in their daily work. Considerable effort is put into training anaesthetists, but little has been done either in research or improving awareness of the intangible components of the anaesthesia system that affect safety, such as decision-making. The purpose of this article is to apply the principles of decision-making to anaesthesia practice.
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Anaesth Intensive Care · Oct 1995
Randomized Controlled Trial Clinical TrialRectal indomethacin potentiates spinal morphine analgesia after caesarean delivery.
This double-blind, randomized study was designed to evaluate the use of indomethacin (Indocid, MSD) following caesarean delivery performed under spinal anaesthesia. Thirty ASA I-II women presenting for elective caesarean were recruited. Spinal anaesthesia was performed in a standard manner using hyperbaric bupivacaine, fentanyl and morphine. ⋯ There were no reported adverse neonatal or maternal effects from the use of indomethacin. Rectal indomethacin use following caesarean delivery leads to significantly improved pain relief compared with placebo. The combination of spinal morphine and rectal indomethacin leads to high-quality postoperative analgesia.
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Anaesth Intensive Care · Oct 1995
Randomized Controlled Trial Comparative Study Clinical TrialProspective clinical evaluation of two combined spinal-epidural kits.
One hundred combined spinal epidural kits (Portex, n = 51, Mallinckrodt, n = 49) were evaluated clinically by twelve anaesthetists with respect to performance of the loss-of-resistance syringe, epidural needle and spinal needle, and success in establishing single-segment combined spinal-epidural anaesthesia for caesarean section. Similar components included a plastic loss-of-resistance device, a Tuohy epidural needle, 26 or 27 gauge pencil-point spinal needle and closed end, three-lateral-eye epidural catheter. The Mallinckrodt kit incorporated a "back-eye" design for exit of the spinal needle from the epidural needle. ⋯ Most anaesthetists preferred the Mallinckrodt kit packaging and the Portex loss-of-resistance syringe, although the latter may have been biased by familiarity with this device. The portex spinal needle was more likely to be felt penetrating the dura (P = 0.02) and aspiration of cerebrospinal fluid was more frequently described as easy (P = 0.01). The most common criticisms of both kits were difficulty controlling the spinal needle position after entry into the subarachnoid space and subjectively, a high degree of resistance to injection through the spinal needle.
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Anaesth Intensive Care · Oct 1995
Randomized Controlled Trial Comparative Study Clinical TrialSingle-dose prophylaxis for postoperative nausea and vomiting after major abdominal surgery: ondansetron versus droperidol.
The new antiemetic ondansetron is effective for the prophylaxis and treatment of postoperative nausea and vomiting (PONV), but has been subject to limited comparative evaluation in surgical inpatients. Two hundred and seventy women having abdominal gynaecological surgery were investigated for 24 hours postoperatively in a randomized, double-blind, placebo-controlled study of intraoperative intravenous ondansetron 8 mg (n = 83), droperidol 2.5 mg (n = 89) or saline placebo (n = 87). Patients receiving either ondansetron or droperidol remained likely to vomit, although the incidence was significantly reduced compared with placebo (72% and 83% versus 91%, P < 0.01). ⋯ Ondansetron reduced the risk of experiencing nausea after six hours postoperatively and the risk of vomiting, with respect to the total number of episodes, in the first 24 hours. It was no better than droperidol, however, in reducing the incidence of vomiting or the need for antiemetic treatment during the first postoperative day, whether or not patients had a past history of PONV. It was no better than droperidol, however, in reducing the incidence of vomiting or the need for antiemetic treatment during the first postoperative day, whether or not patients had a past history of PONV.