Anaesthesia and intensive care
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Anaesth Intensive Care · Sep 2008
Randomized Controlled Trial Clinical TrialEvaluation of nasopharyngeal oxygen, nasal prongs and facemask oxygen therapy devices in adult patients: a randomised crossover trial.
Nasopharyngeal oxygen (NPO) therapy may overcome some of the difficulties associated with nasal prongs and facemask oxygen delivery devices. In response to a lack of published studies of NPO therapy in adults, we conducted a prospective randomised crossover trial to compare the effectiveness of NPO, nasal prongs (NP) and facemasks (FM) when used in an adult population (n = 37) from the intensive care unit and general hospital wards. We measured oxygen saturation (SpO2) using pulse oximetry, oxygen flow (litres per minute), respiration rate (per minute) and comfort using a horizontal visual analogue scale. ⋯ There was no significant difference in patients' respiratory rates (NP 19.9 +/- 3.2, NPO 19.9 +/- 3.0, FM 19.8 +/- 3.1 per minute, P = 0.491). In terms of comfort, patients rated NP higher than NPO and FM using a horizontal visual analogue scale (100 mm = most comfortable) (NP 65.5 +/- 14.3, NPO 62.8 +/- 19.4, FM 49.4 +/- 21.4 mm, P < 0.001). We conclude that for adult patients, nasal prongs and nasopharyngeal oxygen therapy consume less oxygen and provide greater comfort than facemasks while still maintaining SpO2 > or = 95%.
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Anaesth Intensive Care · Sep 2008
Analgesic efficacy using loss of resistance to air vs. saline in combined spinal epidural technique for labour analgesia.
Identification of the epidural space is often performed using the loss of resistance technique to either air or saline. We sought to investigate if the medium used affected the quality of analgesia obtained by parturients who received labour epidurals. We conducted a retrospective audit of labour epidurals performed on nulliparous parturients in our institution from May 2003 to March 2005. ⋯ However patients in the air group had a higher incidence of recurrent breakthrough pain P = 0.023). We also identified three other factors that were associated with an increased incidence of recurrent breakthrough pain; administration of pre-block oxytocin, sitting position of the parturient during the procedure and the use of intrathecal bupivacaine for induction of analgesia. Our findings suggest that a loss of resistance to air is associated with a higher incidence of recurrent breakthrough pain among parturients who received combined spinal epidural analgesia for labour than a loss of resistance to saline.
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Anaesth Intensive Care · Sep 2008
Randomized Controlled Trial Comparative StudyComparison of 2% lignocaine with adrenaline and fentanyl, 0.75% ropivacaine and 0.5% levobupivacaine for extension of epidural analgesia for urgent caesarean section after low dose epidural infusion during labour.
Low dose local anaesthetic and fentanyl epidural solutions are commonly 'topped-up' for urgent caesarean section. However, the block characteristics associated with newer local anaesthetics such as ropivacaine 0.75% and levobupivacaine 0.5% have not been fully determined. In a randomised double-blinded controlled clinical trial, we compared 2% lignocaine with adrenaline and fentanyl (LAF), 0.75% ropivacaine and 0.5% levobupivacaine for extension of low dose epidural analgesia for urgent caesarean section in 90 Asian parturients. ⋯ Levobupivacaine provided a longer duration of sensory block compared to LAF but a similar duration to 0.75% ropivacaine. Under the conditions of this study there was no significant difference in time to surgical readiness (defined as loss of sensation to cold to T4) between LAF, 0.75% ropivacaine and 0.5% levobupivacaine groups. Ropivacaine and levobupivacaine are suitable alternatives for extending epidural analgesia for urgent caesarean section.