Anaesthesia and intensive care
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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 TrialView of the larynx obtained using the Miller blade and paraglossal approach, compared to that with the Macintosh blade.
The purpose of this study was to determine if laryngoscopy using a Miller blade with a paraglossal approach would yield an improved view of the larynx compared to that obtained with a Macintosh blade using the standard approach. One-hundred and sixty-one patients, scheduled for elective surgery requiring tracheal intubation, voluntarily participated in this study. Patients were randomly assigned to one of the two groups (Miller vs. ⋯ A grade 1 Cormack and Lehane view of the larynx was obtained in 96.5% of cases in the Miller group compared with 85% in the Macintosh group (P = 0.02). Direct laryngoscopy using the Miller blade and paraglossal approach, afforded a much-improved view of the larynx in the majority of cases. For this reason trainees should learn laryngoscopy using both blades.
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Anaesth Intensive Care · Sep 2008
Case ReportsAbdominal compartment syndrome complicating paediatric extracorporeal life support: diagnostic and therapeutic challenges.
We report three paediatric cases, and summarise the reported experience in two others, with cardiorespiratory failure requiring extracorporeal life support for which supportive pump flows could not be maintained due to abdominal compartment syndrome. In two of our patients, the mechanism of abdominal compartment syndrome was massive intra-abdominal fluid extravasation secondary to sepsis, while in the third, the mechanism was post-traumatic intra-abdominal haemorrhage. ⋯ Once correctable causes of inadequate venous cannula drainage have been excluded, abdominal compartment syndrome should be considered in any patient on extracorporeal life support with a taut abdomen and reduced venous return. If abdominal compartment syndrome can be proven or is strongly suspected, there may be a role for selective decompressive laparotomy.
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Anaesth Intensive Care · Sep 2008
Evaluation of an Oxford Miniature Vaporizer placed in-circuit during the maintenance phase of low-flow anaesthesia.
The aim of the study was to assess Oxford Miniature Vaporizer output when mounted in-circuit during the maintenance phase of anaesthesia, using isoflurane, controlled ventilation and a fresh gas flow rate less than 1 l/min. Twenty patients of ASA Physical Status I and II were recruited from routine general surgical lists. All patients were paralysed and ventilated. ⋯ At a dial setting of 0.5, the Oxford Miniature Vaporizer produced a steady end-tidal isoflurane of 0.63% (95% confidence interval 0.60 to 0.66). However, when the dial was turned to 1.0 the output was almost always excessive and had to be reduced. These findings indicate that a stable, predictable and clinically useful output can be achieved when the Oxford Miniature Vaporizer is positioned in-circuit using low-flow and controlled ventilation.
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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%.