Anaesthesia and intensive care
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Anaesth Intensive Care · Dec 1999
Randomized Controlled Trial Comparative Study Clinical TrialA prospective randomized clinical assessment of a new pigtail central venous catheter in comparison with standard alternatives.
The Cook Pigtail central venous catheter (CVC) has been designed to diminish the risk of vascular perforation and consequent cardiac tamponade. With the participation of 12 consultant anaesthetists and 19 registrars, adults undergoing elective surgery were randomized to receive either a Pigtail (n = 101) or their consultant anaesthetists' "standard" CVC (n = 102). Median ease of insertion was rated 8 for Pigtail CVCs and 9 for standards (10 being best; P = 0.001). ⋯ No significant difference was found in insertion time or radiographically assessed tip depth for standard and Pigtail central venous catheters. A perforated right atrium of uncertain cause occurred in a patient who received an Arrow triple-lumen central venous catheter. Participating consultant anaesthetists preferred their "standard" central venous catheter for routine use, but five indicated that they would select a Cook Pigtail where long-term use was planned because of in vitro evidence of its greater safety.
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Anaesth Intensive Care · Dec 1999
Randomized Controlled Trial Clinical TrialPharmacokinetics of paracetamol in adults after cardiac surgery.
The pharmacokinetics of paracetamol in adults after cardiac surgery have not been described. Twenty patients were randomized to receive either paracetamol 2 g through a nasogastric tube and as a suppository eight hours later or vice versa. Arterial blood samples were taken at 0.5, one, two, four, six and eight hours after dosing. ⋯ Absorption after nasogastric administration was slow compared to healthy adults (Tabs 0.06 to 0.7 h) and the bioavailability was half that expected, due to nasogastric loss. Parameter estimates had large variability. Paracetamol is unlikely to have useful clinical impact in the majority of patients when standard doses (6 g/day) are given on day 1 after cardiac surgery.
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Epidural abscess is a rare complication of epidural block and occasionally presents in the post partum period. A case is described where a thoracolumbar abscess presented with backache and headache 10 days after an apparently uneventful block for labour and caesarean section. The abscess was treated medically with a satisfactory outcome. The literature is reviewed in order to assess several recent reports of infectious complications of epidural block in obstetric patients.