Anaesthesia and intensive care
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Anaesth Intensive Care · Jan 2014
Randomized Controlled Trial Comparative StudyRandomised comparison of an end-hole, triple-hole and novel six-hole catheter for continuous interscalene analgesia.
Epidural analgesia studies and a recent continuous peripheral nerve block study suggest multi-hole perineural catheters perform better than end-hole catheters. Confounding catheter positioning issues limit interpretation of the latter study. One hundred and fifty-six patients receiving an anterolateral interscalene catheter for elective shoulder surgery were randomised to three groups: following out-of-plane ultrasound confirmation of the needle tip immediately lateral to the C5/6 roots, an end-hole (n=52), triple-hole (n=53) or six-hole (n=51) non-stimulating catheter was positioned 3 cm beyond the needle tip. ⋯ Catheter threading difficulty was more common for the square-tipped end-hole catheters (end-hole=19% versus triple-hole=6%, six-hole=0%, P >0.001). This study found no evidence to support catheter orifice configuration significantly affecting the quality of continuous peripheral nerve blockade. These findings are in contrast to epidural catheter studies, and suggest that anatomical factors have a significant bearing on whether multi-orifice catheters confer advantage over the single-orifice design.
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Anaesth Intensive Care · Jan 2014
Randomized Controlled TrialParecoxib and paracetamol for pain relief following minor day-stay gynaecological surgery.
Paracetamol and non-steroidal anti-inflammatory drugs are often administered for postoperative analgesia. Dilatation and curettage, with or without hysteroscopy, is a common day-stay procedure that is associated with pain that is partly mediated by prostaglandins. This study aimed to investigate the analgesic efficacy of adjunctive paracetamol and parecoxib in this setting. ⋯ There were no significant differences in patient satisfaction or recovery. We conclude that paracetamol or parecoxib does not produce a clinically important reduction in pain in this setting. Women having uterine curettage and receiving intravenous fentanyl do not appear to benefit from administration of these non-opioid analgesics.
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Anaesth Intensive Care · Jan 2014
Comparative StudyA ten-year audit of fresh gas flows in a New Zealand hospital: the influence of the introduction of automated agent delivery and comparisons with other hospitals.
Reducing fresh gas flow (FGF) rates with volatile anaesthetics reduces waste, with positive financial and environmental consequences. We have audited FGF since 2001 by analysis of data collected from anaesthetic machines. We recently introduced Aisys(®) (GE Healthcare, Madison, WI, USA) machines that allow automated control of end-tidal levels of volatile anaesthetics. ⋯ The proportion of time spent in automated delivery mode has increased from 35% to 63%. Users valued the workload reduction with end-tidal control. Our findings suggest that in daily practice, with a wide range of practitioners at different levels of training and a broad patient mix, mean flow rates of around 1.3 l/minute with median flows in the range 0.5 to 1.0 l/minute are achievable targets.
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Anaesth Intensive Care · Jan 2014
Clarifying the role of activated charcoal filters in preparing an anaesthetic workstation for malignant hyperthermia-susceptible patients.
Malignant hyperthermia (MH) is a life-threatening condition caused by exposure of susceptible individuals to volatile anaesthetics or suxamethonium. MH-susceptible individuals must avoid exposure to these drugs, so accurate and reproducible processes to remove residual anaesthetic agents from anaesthetic workstations are required. Activated charcoal filters (ACFs) have been used for this purpose. ⋯ We found that placement of filters in an unprepared, saturated circuit was insufficient to safely prepare an anaesthetic workstation. Following flushing of the anaesthetic workstation with high-flow oxygen for 90 seconds, a circuit and soda lime canister change and the placement of an ACF on the inspiratory limb, we were able to safely prepare a workstation in less than three minutes. A single filter on the inspiratory limb was able to maintain a clean circuit for 12 hours, with gas flows dropped from 10 lpm to 3 lpm after 90 minutes or removal of the filter after 90 minutes if high gas flows were maintained.