Anaesthesia and intensive care
-
Anaesth Intensive Care · Feb 2002
Randomized Controlled Trial Comparative Study Clinical TrialDiclofenac or paracetamol for analgesia in paediatric myringotomy outpatients.
This prospective, randomized, double-blind study compared the analgesic efficacy of oral diclofenac resinate 0.5 mg.kg(-1) with paracetamol 15 mg/kg(-1) for control of postoperative pain in paediatric patients for outpatient bilateral myringotomy and tube insertion. Paracetamol, the most commonly used oral analgesic for paediatric patients, was compared with a new palatable syrup formulation of diclofenac. Sixty-three ASA 1 orA SA 2 children aged one year and above were randomly assigned to receive diclofenac (Group A) or paracetamol (Group B). ⋯ Overall, CHEOPS scores were low for both groups at all times and did not differ between the groups at any time. Twenty per cent of the diclofenac group and 27% of the paracetamol group required rescue analgesia (not statistically significant). The efficacy of diclofenac 0.5 mg x kg(-1) and paracetamol 15 mg x kg(-1) as oral analgesic premedication for BMT was comparable in children receiving an anaesthetic which included intraoperative administration of fentanyl 1 microg x kg(-1).
-
Anaesth Intensive Care · Feb 2002
Review Case ReportsAwake fibreoptic intubation under remifentanil and propofol target-controlled infusion.
We present the first report of the use of remifentanil and propofol target-controlled infusion to sedate a patient with a difficult airway undergoing awake fibreoptic intubation. This regimen was rapidly titratable, aided suppression of airway reflexes, maintained patient comfort and cooperation and did not compromise spontaneous respiration. The literature regarding infusion rates and potential complications of this technique is reviewed.
-
Anaesth Intensive Care · Feb 2002
Comparative Study Clinical TrialAn evaluation of non-invasive blood pressure (NIBP) monitoring on the wrist: comparison with upper arm NIBP measurement.
The arm is the traditional site for application of an oscillometric non-invasive blood pressure (NIBP) cuff This study, which compares upper arm NIBP to wrist NIBP, involved 510 same arm sequential paired blood pressure (BP) measurements in 85 volunteers. Wrist NIBP consistently overestimated mean arterial, systolic and diastolic pressure by approximately 10 mmHg. Ninety per cent of the mean arterial pressure differences at the wrist were within a range of +/- 9 mmHg around a mean difference of 10.6 mmHg. ⋯ The diastolic pressure difference was 10.2 mmHg with 90% of differences between +/- 9 mmHg. With the device used and within the normal blood pressure range, compensation can be performed by subtracting 10 mmHg from the measured values or simply by elevating the wrist about 15 cm and taking the BP at face value. Wrist NIBP may be a viable clinical alternative in situations where difficulty occurs with upper arm NIBP measurement.
-
Anaesth Intensive Care · Feb 2002
Non-bronchoscopic bronchoalveolar lavage in the microbiological diagnosis of pneumonia in mechanically ventilated patients.
A prospective study comparing standardized non-bronchoscopic bronchoalveolar lavage (sNB-BAL) and non-specific endotracheal aspirate (NsETA) in the microbiological diagnosis of pneumonia in mechanically ventilated patients is described. One hundred episodes in 82 mechanically ventilated patients with or without radiological and clinical diagnostic criteria of pneumonia were studied. NsETA and sNB-BAL was performed on the day of study. ⋯ Colonization rates with NsETA were significantly higher compared to sNB-BAL (P value <0.0001). No patient had complications attributable to the sNB-BAL procedure. We conlude that sNB-BAL is a safe, effective, sensitive, specific and inexpensive procedure for the serial evaluation of pneumonia in mechanically ventilated patients.
-
Anaesth Intensive Care · Feb 2002
Case ReportsSystemic reperfusion injury during arm replantation requiring intraoperative amputation.
This case describes the attempted replantation of an arm following its traumatic amputation. After a five-and-a-half hour ischaemic time, perfusion of the arm was re-established. However over the ensuing hours, the patient developed hyperkalaemia, acidaemia and severe hypotension requiting high dose inotropic support. Ultimately re-amputation was necessary to treat the systemic effects of the ischaemia reperfusion syndrome.