Anaesthesia and intensive care
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Anaesth Intensive Care · Dec 2000
Randomized Controlled Trial Clinical TrialThe prevention of pulmonary aspiration with control of tracheal wall pressure using a silicone cuff.
A prospective open randomized controlled study was performed to assess the ability of Euromedical ILM endotracheal tube cuff (silicone cuff) to prevent pulmonary aspiration. The inflation characteristics of this silicone cuff enables the control of tracheal wall pressure. The silicone cuffed tube was shortened and an adjustable flange was used to convert it to a cuffed tracheostomy tube. ⋯ There were six patients in the Shiley group and six patients in the silicone cuff group. Dye leaked to the trachea in six (100%) of the Shiley group compared with none (0%) of the silicone cuff group (P = 0.001). This study confirms the effectiveness of this silicone cuff at preventing aspiration and the high incidence of leakage with the conventional high-volume low-pressure tracheostomy tube cuff.
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Anaesth Intensive Care · Dec 2000
Randomized Controlled Trial Comparative Study Clinical TrialEffect of short-term ketorolac infusion on recovery following laparoscopic day surgery.
This study tested the hypothesis that, by the addition of parenteral ketorolac to an oral analgesic regimen for one day following laparoscopic surgery, analgesia would be improved and thus the return of normal function hastened. Seventy-two female patients were randomly assigned to receive ketorolac 10.5 mg subcutaneously at the end of surgery followed by a subcutaneous infusion of 1.75 mg/h for 24 to 36 hours, or an equivalent volume of saline. All patients were provided with codeine tablets (30 mg) for analgesia if required. ⋯ Pain scores in the ketorolac group were not significantly lower than in the saline group on the first postoperative day (P = 0.052) and subsequently remained similar. Levels of discomfort on performing six common activities were similar in the two groups over the four-day postoperative period. We conclude that, despite beneficial effects during the period of ketorolac administration, there was no continuing benefit after this time other than reduced analgesic use, and no improvement in the patients' ability to perform common activities.
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Anaesth Intensive Care · Dec 2000
Case ReportsIntraoperative high-dose remifentanil in a patient on naltrexone therapy.
Naltrexone hydrochloride is a synthetic opioid receptor antagonist recently used in efforts to provide rapid opioid detoxification. Other clinical uses include alleviating itch due to cholestasis or uraemia. We report a case where unrecognised naltrexone therapy for itch affected anaesthesia, resulting in high opioid requirements. We also discuss other analgesic options utilized.
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Anaesth Intensive Care · Dec 2000
Clinical TrialRelative cost of autologous red cell salvage versus allogeneic red cell transfusion during abdominal aortic aneurysm repair.
The costs of washed autologous red cell concentrate obtained by intraoperative red cell salvage were compared to the costs of allogeneic packed red cell transfusion during 110 consecutive abdominal aortic aneurysm repairs. The mean volume of scavenged blood during elective procedures was 1350 ml (range 350 to 6675 ml, n = 90) and emergency procedures 2750 ml (range 750 to 9400 ml, n = 20). ⋯ During emergency repairs, washed autologous red cells ($83 per 285 ml unit) were less expensive than allogeneic packed red cells. These findings indicate that, compared with the use of allogeneic packed red cells, red cell salvage during emergency abdominal aortic aneurysm repair can be justified on an economic basis alone, and that routine red cell salvage during elective repair can achieve the benefits of autologous blood at little extra cost to the community.
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Anaesth Intensive Care · Dec 2000
Knowledge of cardiopulmonary resuscitation protocols and level of anaesthetic training.
Inadequate recall of resuscitation protocols has contributed to poor performance of resuscitation in simulation studies. We asked, does the level of anaesthesia training affect knowledge of cardiopulmonary resuscitation protocols? We used a questionnaire that covered the areas of basic life support, advanced adult life support and paediatric life support. ⋯ The consultant group performed worse than all other groups for the basic life support and advanced life support questions. We suggest yearly resuscitation training for all anaesthetists and anaesthesia trainees.