Anaesthesia and intensive care
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Anaesth Intensive Care · Jun 2004
Randomized Controlled Trial Comparative Study Clinical TrialThe differential flow of epidural local anaesthetic via needle or catheter: a prospective randomized double-blind study.
The extent of epidural anaesthesia and pattern of spread of contrast medium, using different injection techniques, has not been well documented. Therefore, in this prospective, randomized double-blind study, the extent of anaesthesia and pattern of spread of contrast medium following an epidural bolus injection, via either a Tuohy needle or an epidural catheter, were compared. The study had two parts. ⋯ No differences were found in the extent of sensory anaesthesia or the spread of contrast medium. Twenty per cent of catheter tips lay outside the lateral margins of the vertebral bodies. We found that an epidural bolus injection, via either a Tuohy needle or a catheter, made no difference in regard to spread of local anaesthetic or contrast medium in the epidural space.
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Anaesth Intensive Care · Jun 2004
Randomized Controlled Trial Comparative Study Clinical TrialCrystalloid preload versus rapid crystalloid administration after induction of spinal anaesthesia (coload) for elective caesarean section.
Current methods of crystalloid preload administration prior to spinal anaesthesia for elective caesarean section are relatively ineffective in preventing hypotension. This study examined the relevance of the timing of the fluid administered. Fifty women were randomly allocated to receive either 20 ml x kg(-1) of crystalloid solution during 20 minutes prior to induction of spinal anaesthesia (preload), or an equivalent volume by rapid infusion immediately after induction (coload). ⋯ There was no between-group difference in either the total cumulative dose, or in the total number of doses of ephedrine. Neonatal outcomes among the two groups were similar. Rapid crystalloid administration after, rather than over 20 minutes before the induction of spinal anaesthesia for elective caesarean section, may be advantageous in terms of managing maternal blood pressure prior to delivery.
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Anaesth Intensive Care · Jun 2004
Randomized Controlled Trial Comparative Study Clinical TrialComparison of laryngeal mask airway with tracheal tube for ophthalmic surgery in paediatric patients.
This study of sixty ASA grade 1 or 2 children, aged 1 to 12 years, undergoing elective ophthalmic procedures, compared the use of the laryngeal mask airway (LMA) with that of an endotracheal tube. Changes in intraocular pressure and haemodynamic parameters, and intraoperative and postoperative complications were measured Patients were randomly allocated into two groups of 30 patients. In group 1, the airway was secured with an LMA and in group 2 with an endotracheal tube. ⋯ The incidence of postoperative coughing was lower in the LMA group, but the incidence of vomiting higher. Two patients had displacement of the LMA during the procedure. We conclude that the use of an LMA is associated with less increase in intraocular pressure than the use of an endotracheal tube in children.
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Anaesth Intensive Care · Jun 2004
Case ReportsBilateral adductor vocal cord paresis following endotracheal intubation for general anaesthesia.
Recurrent laryngeal nerve palsy is a rare complication of endotracheal intubation. We report a case of bilateral vocal cord palsy following endotracheal intubation for general anaesthesia. ⋯ Compression of the anterior branch of the recurrent laryngeal nerve between the cuff of the endotracheal tube and the posterior part of the thyroid cartilage was the likely mechanism. Ensuring that the cuff of the endotracheal tube is distal to the cricoid cartilage and that the pressure in the cuff is kept to the minimum required to prevent a gas leak should prevent this complication.
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Anaesth Intensive Care · Jun 2004
Case ReportsRecurrent atrial tachyarrhythmia triggered by percutaneous balloon rhizotomy of the trigeminal nerve.
Stimulation of sensory branches of the trigeminal nerve is known to cause sudden bradycardia (trigeminocardiac reflex). However we report a case where percutaneous balloon rhizotomy of the trigeminal ganglion provoked atrial tachyarrhythmias during two separate treatments. ⋯ Our case demonstrates that surgery involving the trigeminal nerve may cause variable cardiovascular effects that are often clinically significant. Possible mechanisms and management of arrhythmias in this setting are discussed.