Anaesthesia and intensive care
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Anaesth Intensive Care · Feb 2004
Randomized Controlled Trial Comparative Study Clinical TrialThe addition of sufentanil, tramadol or clonidine to lignocaine for intravenous regional anaesthesia.
This study was designed to evaluate the effect of sufentanil, tramadol or clonidine added to lignocaine for intravenous regional anaesthesia. We investigated the onset and duration of sensory and motor block, the quality of the anaesthesia, intraoperative and postoperative haemodynamics, intraoperative and postoperative pain and sedation. Sixty patients undergoing ambulatory hand surgery received intravenous regional anaesthesia using 35 ml of 0.5% lignocaine and either 5 ml saline (Group L, n = 15); sufentanil 25 micrograms (Group LS, n = 15); tramadol 100 mg (Group LT, n = 15) or clonidine 1 microgram.kg-1 (Group LC, n = 15). ⋯ Compared to the other groups, in Group L the onset of sensory block was longer, the time to initial tourniquet pain was shorter and the intraoperative tourniquet pain scores and use of the opioid were higher (P < 0.05). The quality of anaesthesia in Groups LS, LT and LC was better than in Group L (P < 0.05). In conclusion, the addition of sulfentanil, tramadol or clonidine to lignocaine shortened the onset of the sensory block, delayed the onset time of the tourniquet pain and reduced the intraoperative consumption of opioid, but did not affect postoperative pain.
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Anaesth Intensive Care · Feb 2004
Evaluation of the Intubating Laryngeal Mask Airway used by occasional intubators in simulated trauma.
This observational study assessed the potential role of the intubating laryngeal mask airway (ILMA) for use by emergency care givers with limited laryngoscopy skills. Six ambulance officers with advanced airway training, five doctors with intubation experience and five doctors without intubation experience were given a short instruction course on the use of the ILMA. They subsequently used the device on 80 consenting subjects anaesthetized for elective surgery after the application of cricoid pressure and manual in-line stabilization of the cervical spine. ⋯ The feedback forms were strongly supportive of a prehospital trial and also of having an ILMA available during all intubations. Participants almost universally rated the ILMA as easy to use. This study supports further evaluation of the ILMA in a large prehospital trial.
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This is a preliminary report on the use of the modified Airway Management Device in 50 spontaneously breathing patients undergoing elective day care surgery. We were successful in establishing a clear airway in all 50 patients, 46 of these patients had a patient airway on the first attempt. ⋯ Partial airway obstruction during maintenance of anaesthesia occurred in three cases requiring only minor manipulations. Our result showed that the Airway Management Device may be used as an alternative airway management in anaesthesia.
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Anaesth Intensive Care · Feb 2004
An assessment of small simulators used to teach basic airway management.
This study assessed small simulators sold for teaching basic airway management. The assessment used criteria based on guidelines produced by the Australian Resuscitation Council and our experience teaching health professional trainees. Criteria included how well the simulators demonstrated manoeuvres to open the airway, mouth-to-mouth and mask-to-mouth expired air resuscitation and artificial ventilation using a bag and mask. ⋯ Generally, models with hard surfaces tended to be less realistic in both look and feel compared to those with flexible "skin". Realism of lung inflation and its relationship to airway opening manoeuvres varied greatly between simulators. The Little Anne small simulator functioned most realistically in our tests.
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Anaesth Intensive Care · Feb 2004
Criteria for elective admission to the paediatric intensive care unit following adenotonsillectomy for severe obstructive sleep apnoea.
During the period 1997 to 2002, 42 children were electively admitted to the Paediatric Intensive Care Unit at the John Hunter Children's Hospital following adenotonsillectomy for severe obstructive sleep apnoea. Forty children had a preoperative sleep study, of which 33 were complete polysomnograms. Of the 42 children admitted, 35 required no intervention while seven (17%) required an additional intervention beyond supplemental oxygen. Our criteria for elective admission to Paediatric Intensive Care following adenotonsillectomy for severe obstructive sleep apnoea are presented.