Anaesthesia and intensive care
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Anaesth Intensive Care · Mar 2014
Randomized Controlled TrialThe effects of different doses of caudal morphine with levobupivacaine on postoperative vomiting and quality of analgesia after circumcision.
The study aim was to investigate the effect of three different morphine doses added to levobupivacaine 0.125% for caudal analgesia after circumcision surgery in children, particularly in relation to the frequency of postoperative vomiting within the first 24 hours following surgery. Two hundred and forty patients aged 5 to 12 years undergoing circumcision were included in the study. Following induction, caudal 0.125% levobupivacaine 0.5 ml/kg was given after adding 7.5, 10 or 15 µg/kg morphine. ⋯ Five percent of the 7.5 µg/kg group and none of the patients in the other groups required paracetamol within the first 12 hours, and there was a significantly greater need for rescue paracetamol over the 24 hours in the 7.5 group versus the 15 µg/kg group (P=0.013). Postoperative analgesic durations were long and did not differ between groups (1273±338, 1361±192 and 1426±48 minutes, respectively, P=0.08). In conclusion, because the incidence of vomiting is very low, the duration of postoperative analgesia is long and a dose of 7.5 µg/kg caudal morphine is much lower than doses previously reported to be associated with respiratory depression, this study supports the use of 7.5 µg/kg caudal morphine added to 0.125% levobupivacaine for circumcision surgery.
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Anaesth Intensive Care · Mar 2014
Randomized Controlled TrialA randomised controlled trial of ultrasound-assisted spinal anaesthesia.
Pre-procedural ultrasound scanning has been used to facilitate spinal anaesthesia in patients with difficult anatomical landmarks and shown to improve first-attempt success rates in some studies. We studied whether pre-procedural ultrasound scanning improved first-attempt success rate and decreased time taken for the procedure in the general adult population. In this prospective, randomised controlled trial, 170 American Society of Anesthesiologists 1 to 3 patients aged between 21 and 80 years were recruited. ⋯ There were no differences in complications. As there was no statistically significant difference in first-attempt success rates between the two groups, existing evidence for routine pre-procedural scanning for all patients is inadequate. The current use of pre-procedural ultrasound scanning will probably be limited to selected patients where spinal anaesthesia may be technically challenging with conventional methods.
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Anaesth Intensive Care · Mar 2014
Randomized Controlled TrialEffects of different general anaesthetic techniques on immune responses in patients undergoing surgery for tongue cancer.
The aim of this study was to investigate the effects of different general anaesthesia techniques on immune responses in patients undergoing surgery for tongue cancer. Sixty American Society of Anesthesiologists physical status 1 or 2 patients undergoing elective reconstructive surgery for tongue cancer were randomised to three groups. Group 1 received propofol induction and maintenance (TIVA), group 2 received propofol induction and sevoflurane maintenance (MIXED) and group 3 received sevoflurane induction and maintenance (SEVO). ⋯ The percentages of CD3(+) cells, CD3(+)CD4(+) cells and natural killer cells, and the CD4(+)/CD8(+) ratios were significantly lower in the MIXED groups and SEVO groups but not the TIVA group at T6 as compared with T0 (P <0.05). There were minor but statistically significant differences in the percentages of CD3(+) cells, CD3(+)CD4(+) cells and natural killer cells, and the CD4(+)/CD8(+) ratios between the SEVO group and the TIVA group at T2approxT6 (P <0.05). These findings suggest that propofol has slightly less effect on cellular immune responses than sevoflurane.
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Anaesth Intensive Care · Mar 2014
Letter Case ReportsTracheal tube compression in an obese patient.