Anaesthesia and intensive care
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Anaesth Intensive Care · Nov 2009
Comparative Study Controlled Clinical TrialComparison of forehead Max-Fast pulse oximetry sensor with finger sensor at high positive end-expiratory pressure in adult patients with acute respiratory distress syndrome.
In the critical care setting it may be difficult to determine an accurate reading of oxygen saturation from digital sensors as a result of poor peripheral perfusion. Limited evidence suggests that forehead sensors may be more accurate in these patients. We prospectively compared the accuracy of a forehead reflectance sensor (Max-Fast) with a conventional digital sensor in patients with acute respiratory distress syndrome during a high positive end-expiratory pressure (PEEP) recruitment manoeuvre (stepwise recruitment manoeuvre). ⋯ The greater variability in forehead measures taken at maximum PEEP was reflected in the unusually large precision estimates of 4.24% associated with these measures. No absolute differences from arterial measures taken at any other time points were significantly different. The finger sensor is as accurate as the forehead sensor in detecting changes in arterial oxygen saturation in adults with acute respiratory distress syndrome and it may be better at levels of high PEEP such as during recruitment manoeuvres.
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Anaesth Intensive Care · Nov 2009
Case ReportsA technique that may improve the reliability of endobronchial blocker positioning during adult one-lung anaesthesia.
We describe a novel technique, previously applied to small children, for adult one-lung anaesthesia in which a single-lumen endotracheal tube is used with an endobronchial balloon blocker The main aims of the technique are to reduce the likelihood of cephalad displacement of the balloon into the trachea and to facilitate directional placement of the endobronchial balloon. We present five illustrative cases of one-lung anaesthesia in patients of adult size, in which the endotracheal tube-endobronchial balloon technique was considered preferable to the use of a double-lumen tube technique. The situations included difficult intubation, need for postoperative ventilation, a tortuous trachea and an unexpected need to perform one-lung anaesthesia. The technique involved deliberate placement of the endotracheal tube tip near the carina to block cephalad dislodgement of the blocker The chance of the balloon blocking the endotracheal tube tip could be further reduced by having the intraluminal endobronchial balloon blocker emerge through the Murphy eye.
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Anaesth Intensive Care · Nov 2009
Case ReportsRegional anaesthesia and analgesia on the front line.
Deployment to a combat zone with the military poses many challenges to the anaesthetist. One of these challenges is the safe, rapid and comfortable initial wound management and repatriation of wounded combat soldiers to their home country or tertiary treatment facility for definitive care and rehabilitation. The current conflict in Afghanistan is associated with injury patterns that differ from wars such as Vietnam or Korea. This report describes the experience of an Australian military anaesthetist and the value of regional anaesthesia and analgesia for the care of the wounded combat soldier
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Anaesth Intensive Care · Nov 2009
Randomized Controlled Trial Comparative StudyComparison of equipotent doses of ropivacaine-fentanyl and bupivacaine-fentanyl in spinal anaesthesia for lower abdominal surgery.
The aim of this randomised, double-blind study was to compare equipotent doses of plain ropivacaine and bupivacaine (19.5 mg and 13 mg respectively), both with fentanyl 20 microg, for spinal anaesthesia in lower abdominal surgery. After written informed consent had been obtained, 52 ASA I to II male patients scheduled for lower abdominal surgery were randomly assigned to receive intrathecal plain ropivacaine 19.5 mg with fentanyl 20 microg (group R, n =26) or plain bupivacaine 13 mg with fentanyl 20 microg (group B, n =26) in 3 ml. The level and duration of sensory block, intensity and duration of motor block, time to mobilise and patient satisfaction were recorded. ⋯ The duration of motor block (Bromage score >0) was shorter in group R (139+/-39 minutes vs group B 182+/-46 minutes, P <0.05). The duration and intensity of complete motor block (Bromage score=3) were also shorter in group R (90+/-25 minutes vs 130+/-40 minutes, P <0.05). We conclude that plain ropivacaine 19.5 mg plus fentanyl 20 microg is associated with a lower level of sensory block and a shorter duration of motor block when compared to bupivacaine 13 mg plus fentanyl 20 microg for spinal anaesthesia in lower abdominal surgery.