Anaesthesia and intensive care
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Anaesth Intensive Care · Mar 2011
Comparative StudyResponses to dural puncture during institution of combined spinal-epidural analgesia: a comparison of 27 gauge pencil-point and 27 gauge cutting-edge needles.
Pencil-point spinal needles are popular for combined spinal-epidural analgesia because they cause less dural puncture headache than cutting-edge spinal needles. However many parturients move, grimace, vocalise or experience paraesthesia or dysaesthesia during dural puncture when performing 'needle through needle' combined spinal-epidural analgesia. We compared dural puncture responses induced by pencil-point and cutting-edge needles (both 27 gauge). ⋯ Pooled data analysis revealed that pencil-point and cutting-edge needles induced grimacing and movement in 17 (22%) and 2 (5%), spontaneous vocalisation in 4 (5%) and 1 (3%) and was perceived by 13 (17%) and 3 (8%) parturients (P < 0.025, P=NS, P=NS), respectively. Overall, 34 and 6 objective and subjective patient responses (P < 0.005) occurred when inserting these needles, respectively. Dural puncture by a 27 gauge pencil-point needle inserted 'needle through needle' when instituting combined spinal-epidural analgesia induces more iatrogenic responses than a 27 gauge cutting-edge needle.
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Anaesth Intensive Care · Mar 2011
Case ReportsRemoval of an impacted distal airway foreign body using a guidewire and a balloon angioplasty catheter.
Airway aspiration of foreign bodies is relatively common in young children. Visible objects are commonly removed under direct vision using grabbing forceps inserted through a rigid bronchoscope. We describe a case of aspiration of the hollow tip of a plastic pen which lodged distally in the right main bronchus of an older child. ⋯ A novel method was required for successful retrieval, which involved the passage of a guidewire through the centre of the foreign body. A balloon angioplasty catheter was then railroaded over the guidewire through the foreign body and the balloon inflated with saline. This allowed the foreign body to be pulled proximally out of the airway.
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Anaesth Intensive Care · Mar 2011
Randomized Controlled Trial Comparative StudyBedside percutaneous tracheostomy: a prospective randomised comparison of PercuTwist versus Griggs' forceps dilational tracheostomy.
Tracheostomy is considered the airway management of choice for patients who require prolonged mechanical ventilation. The development of percutaneous techniques offers many advantages including the ability to perform the procedure in the intensive care unit. The aim of this study was to compare the controlled rotating dilation method (PercuTwist) and the Griggs' forceps dilational tracheostomy. ⋯ These complications were minor in 18/20 and were not significantly different between the two groups. In conclusion, we consider that the PercuTwist technique is safe despite the longer duration of the procedure. Nevertheless the forceps dilational technique remains our routine procedure.
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Anaesth Intensive Care · Mar 2011
Randomized Controlled TrialNon-invasive ventilation after extubation in patients with chronic obstructive airways disease: a randomised controlled trial.
Non-invasive positive pressure ventilation (NPPV) is a well established therapy for acute respiratory failure in patients with chronic obstructive pulmonary disease, however its role in post-extubation period is uncertain. The objective of this study was to find the effect of NPPV on rate of re-intubation, intensive care unit and hospital stay, and physiological parameters in severe chronic obstructive pulmonary disease patients after planned extubation. Forty patients with severe chronic obstructive pulmonary disease were randomised immediately after planned extubation to receive NPPV (n=20) or conventional therapy (n=20). ⋯ Reintubation rate among NPPV (15%) and conventional (25%) were similar (P=0.44). The duration of intensive care unit stay after extubation (2.05 +/- 2.15 vs 1.55 +/- 0.82 days, P=0.34) and hospital stay (16.10 +/- 6.29 vs 18.25 +/- 7.91 days, P=0.34) in both groups were comparable. Given the load of chronic obstructive pulmonary disease patients and wide availability of NPPV it is safe to recommend its use in these patients soon after extubation, although clear benefit is not documented in this study.