Anaesthesia and intensive care
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Anaesth Intensive Care · Jun 2000
Randomized Controlled Trial Comparative Study Clinical TrialSubhypnotic dose of propofol for the prevention of nausea and vomiting during spinal anaesthesia for caesarean section.
This study was undertaken to evaluate the efficacy of subhypnotic doses of propofol for the prevention of nausea and vomiting in parturients undergoing caesarean section under spinal anaesthesia. In a randomized, double-blinded, placebo-controlled manner, 60 patients received intravenously lignocaine 0.1 mg/kg (for injection pain relief) followed by either placebo (Intralipid) or propofol at subhypnotic dose (1.0 mg/kg/h) (n = 30 of each) immediately after clamping of the fetal umbilical cord. ⋯ No clinically important adverse events were observed in either group. In conclusion, a subhypnotic dose (1.0 mg/kg/h) of propofol is effective for preventing nausea and vomiting in parturients undergoing caesarean section under spinal anaesthesia.
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Anaesth Intensive Care · Jun 2000
The development of a performance indicator to objectively monitor the quality of care provided by an acute pain team.
Quality assurance procedures are essential in the maintenance of clinical standards in medicine. Conventional analysis techniques have difficulty in detecting gradual changes over time. Cumulative sum techniques monitor the frequency with which an event occurs and can detect changes in its frequency as soon as they become statistically significant. ⋯ It shows that periods of suboptimal performance can be readily identified. The prospective use of these techniques in clinical audit may allow the earlier identification and correction of technical or organisational problems. These should lead to improvements in patient care and satisfaction.
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Anaesth Intensive Care · Jun 2000
Randomized Controlled Trial Comparative Study Clinical TrialTracheal intubation with the Macintosh laryngoscope versus intubating laryngeal mask airway in adults with normal airways.
We tested the hypothesis that haemodynamic changes to intubation and postoperative pharyngolaryngeal morbidity are similar for blind intubating laryngeal mask (ILM)-guided compared with laryngoscope-guided tracheal intubation in adults with normal airways. We also compared intubation success rates and airway complications. One-hundred and fifty paralysed, anaesthetized adult patients undergoing elective surgery were randomly assigned to one of three equal-sized groups: 1. blind intubation via the ILM using a straight, silicone tube; 2. intubation with a Macintosh laryngoscope using a straight silicone tube and 3. intubation with a Macintosh laryngoscope using a polyvinyl chloride tube (controls). ⋯ Oesophageal intubation (26 v 0%) and mucosal trauma (19 v 2%) were more common in the ILM group. Hypoxia and postoperative pharyngolaryngeal morbidity were similar among groups. Blind intubation through the ILM offers no advantages over the Macintosh laryngoscope for adult patients requiring intubation for elective surgery with normal airways, but it is a feasible alternative.
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Anaesth Intensive Care · Jun 2000
Measurement of quality of recovery in 5672 patients after anaesthesia and surgery.
Quality of recovery after an operation is an important dimension of the patient's experience and may be related to the quality of anaesthesia care. Satisfaction with anaesthesia is a vital component of quality care but difficult to measure. ⋯ Patients who experienced any of a number of perioperative complications had lower QoR Scores (P < 0.0005). We have further demonstrated the validity and clinical utility of the QoR Score, and in particular, its relationship to patient satisfaction in adult surgical patients.
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Anaesth Intensive Care · Jun 2000
Case ReportsVasopressin effective in reversing catecholamine-resistant vasodilatory shock.
A patient with perforated appendicitis developed progressive vasodilatory shock which was complicated by perioperative acute myocardial infarction. Cardiovascular support included dopamine infusion, and later, intra-aortic balloon counterpulsation balloon pump and noradrenaline and dobutamine infusion. Vasopressin was introduced as a final attempt to reverse the refractory shock and was associated with recovery. The experience with this case suggests that vasopressin may be a valuable adjunct to the treatment of catecholamine-resistant vasodilatory shock.