Anaesthesia and intensive care
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Anaesth Intensive Care · Oct 2001
Randomized Controlled Trial Clinical TrialEffect of age on recovery from remifentanil anaesthesia.
In a prospective, randomized study, the effect of age on recovery from remifentanil anaesthesia was evaluated. Twenty consecutive patients classified as ASA 1 and 2 and having elective laparotomy were recruited to one of two groups based on age (Group 1 age <60 y and Group 2 age >60 y). Remifentanil boluses and infusion were used for induction and maintenance of anaesthesia. ⋯ A P value <0.05 was taken as significant. We found that the younger age group regained spontaneous respiration (0.8+/-0.7 min vs 3.2+/-3.6 min), adequate respiration (3.4+/-3.7 min vs 7.6+/-5.8 min), opened their eyes (0.9+/-1.0 min vs 3.6+/-4.4 min), had their endotracheal tubes removed (5.0+/-4.6 min vs 9.0+/-6.5 min) and were discharged to recovery room (8.8+/-4.3 min vs 14.5+/-7.1 min) earlier than their older counterparts. In conclusion, age was a co-variate for recovery from remifentanil anaesthesia.
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Anaesth Intensive Care · Oct 2001
Randomized Controlled Trial Clinical TrialHypotension in elderly patients undergoing spinal anaesthesia for repair of fractured neck of femur. A comparison of two different spinal solutions.
Intraoperative hypotension is a common and sometimes deleterious event in elderly patients undergoing spinal anaesthesia for repair of hip fractures. The synergism between intrathecal opioids and local anaesthetics may allow a reduction in the dose of local anaesthetic and reduce hypotension, while still maintaining adequate anaesthesia. We studied 42 elderly patients having insertion of a Richards pin and plate and compared 7.5 mg hyperbanic bupivacaine with added fentanyl 20 microg (group BF) to 12.5 mg hyperbaric bupivacaine alone (group B). ⋯ There was no difference in the incidence or severity of hypotension between the two groups. Two patients from group B and one from group BF experienced mild discomfort. Pruritus was more common in group BF.
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Anaesth Intensive Care · Oct 2001
Case ReportsTracheal intubation using suspension laryngoscopy in an infant with Goldenhar's syndrome.
We present a case of a ten-month-old boy with Goldenhar's syndrome and significant retrognathia in whom a tracheostomy was performed to relieve upper airway obstruction. Tracheal intubation was facilitated by direct suspension laryngoscopy using a slotted rigid laryngoscope. We propose this technique as an alternative method for tracheal intubation in infants and young children with a difficult airway. The management of the difficult airway in children with Goldenhar's syndrome is discussed.
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Anaesth Intensive Care · Oct 2001
Comparative StudyHaemodilution-induced enhancement of coagulation is attenuated in vitro by restoring antithrombin III to pre-dilution concentrations.
Moderate haemodilution enhances coagulability in vitro and in vivo as measured by thrombelastography (TEG). The mechanism has never been established. We have conducted an in vitro study to determine whether the effect can be moderated or prevented when the reduction in antithrombin III caused by dilution is prevented by supplementation. ⋯ A predictable drop of AT III (24.2%) occurred with saline dilution, while AT III levels in the AT III/Saline group were similar to the undiluted control. Haemodilution-induced coagulation enhancement is attenuated, but not prevented, if AT III levels are maintained in the normal range. This is in keeping with the established concept of an antithrombin threshold preventing positive coagulation feedback into the intrinsic pathway.