Anaesthesia and intensive care
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Anaesth Intensive Care · Dec 2001
Comparative StudyPost dural puncture headache following combined spinal epidural or epidural anaesthesia in obstetric patients.
A retrospective review of obstetric anaesthesia charts was performed for all parturients receiving regional anaesthesia over a 22-month period. The incidence of headache, post dural puncture headache (PDPH) and various other complications of regional anaesthesia that had been prospectively assessed were noted, as was the anaesthetic technique used (epidural or combined spinal epidural (CSE)). ⋯ Following a CSE technique, the epidural catheter more reliably produced effective analgesia/anaesthesia as compared with a standard epidural technique (1.49% versus 3.18% incidence of replaced catheters respectively). We conclude, based on the results of this retrospective review, that CSE is acceptable with respect to the occurrence of PDPH and that it is possible it is advantageous in relation to the correct placement of the epidural catheter
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A previously healthy woman presented with chest pain and cervical swelling several hours after undergoing surgical removal of third molar teeth. Mediastinal and subcutaneous emphysema was demonstrated by chest X-ray. ⋯ Surgical handpieces that vent the air away from the surgical field should be used during such procedures. The mediastinal and subcutaneous air resolved after oxygen administration.
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Anaesth Intensive Care · Dec 2001
Randomized Controlled Trial Comparative Study Clinical TrialThe effect of the biopatch, a chlorhexidine impregnated dressing, on bacterial colonization of epidural catheter exit sites.
We performed a prospective, randomized study in 55 ASA I to 3 women undergoing elective gynaecological surgery followed by postoperative epidural analgesia. We compared the incidence of bacterial colonization at the epidural exit site following catheter removal between a control group and an experimental group who received a chlorhexidine impregnated dressing (Biopatch, Johnson and Johnson, Arlington, TX, U. ⋯ Positive culture results were found in 11 of 27 (40.1%) patients in the control group compared with one of 29 (3.4%) patients whose epidural catheters were dressed with the Biopatch. We concluded that the Biopatch was effective in reducing bacterial colonization of the epidural catheter exit site.
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Anaesth Intensive Care · Dec 2001
Randomized Controlled Trial Comparative Study Clinical TrialPropofol anaesthesia via target controlled infusion or manually controlled infusion: effects on the bispectral index as a measure of anaesthetic depth.
Target controlled infusions (TCI) of propofol allow anaesthetists to target constant blood concentrations and respond promptly to signs of inappropriate anaesthetic depth. Studies comparing propofol TCI with manually controlled infusion (MCI) reported similar control of anaesthesia, but did not use an objective measure of anaesthetic depth. We therefore tested whether the Bispectral Index (BIS), an electroencephalographic (EEG) variable, is more stable during propofol TCI or MCI. ⋯ There was no difference in absolute performance errors during maintenance of anaesthesia with propofol TCI or MCI (23 +/- 11% vs 23 +/- 9%; P=0.97). The two groups did not differ significantly in performance error, wobble, divergence on haemodynamic changes. We conclude that TCI and MCI result in similar depth of anaesthesia and haemodynamic stability when titrated against traditional clinical signs.