Anaesthesia and intensive care
-
Anaesth Intensive Care · Feb 2000
Sevoflurane anaesthesia with the Komesaroff vaporizer inside the circle system.
This study assessed the safety of sevoflurane anaesthesia using two Komesaroff vaporizers inside the circle with both spontaneous and controlled ventilation. Sevoflurane concentrations were continuously monitored using a mass spectrometer and the anaesthetic depth was easily controlled. ⋯ With continuous monitoring of sevoflurane concentrations, induction and maintenance of anaesthesia using a vaporizer inside the circle is safe during both controlled and spontaneous ventilation. However the high incidence of involuntary movements may limit the feasibility of induction in spontaneously breathing patients.
-
Anaesth Intensive Care · Feb 2000
Cricothyroidotomy and transtracheal high frequency jet ventilation for elective laryngeal surgery. An audit of 90 cases.
We carried out an audit of needle cricothyroidotomy and transtracheal ventilation used during anaesthesia for elective endolaryngeal surgery. The data on 90 consecutive procedures was collected over two years. Patients were anaesthetized using a total intravenous technique. ⋯ There were 12 complications in total. Only three of these were clearly related to the cricothyroid puncture, i.e., one minor bleed and two cases of limited local surgical emphysema. All complications were minor and resolved without sequelae.
-
Anaesth Intensive Care · Dec 1999
Randomized Controlled Trial Comparative Study Clinical TrialPropofol-thiopentone admixture: recovery characteristics.
We have investigated, in a prospective double-blind study, recovery from anaesthesia induced by two admixtures of propofol and thiopentone and compared it with a third group of patients who received propofol and lignocaine. Ninety unpremedicated ASA 1 or 2 patients scheduled for elective gynaecological laparoscopy as a daycase procedure were randomly allocated to receive one of three different mixtures for induction of anaesthesia as part of a standardized anaesthetic: Group P50: propofol 1% 10 ml/thiopentone 2.5% 10 ml, Group P75: propofol 1% 15 ml/thiopentone 2.5% 5 ml, Group P100: propofol 1% 20 ml/lignocaine 1% 4 ml. Recovery from anaesthesia was assessed for up to four hours post-induction by critical flicker fusion threshold and best post-box toy completion time. ⋯ Nor was there any difference between the groups with respect to postoperative analgesia or anti-emetic administration. Utilizing the most sensitive end-point, a sample of nearly 1000 patients in each group would be required to confirm the observed difference with a power of 0.8 based on the data from this study. In comparison with lignocaine, the addition of thiopentone to propofol does not delay recovery from anaesthesia and does not increase postoperative analgesic or anti-emetic requirements.
-
Anaesth Intensive Care · Dec 1999
Meta AnalysisThe effects of nonsteroidal anti-inflammatory drugs (NSAIDs) on postoperative renal function: a meta-analysis.
The aim of this systematic review was to assess the effects of nonsteroidal anti-inflammatory drugs (NSAIDs) on post-operative renal function. Eight randomized placebo-controlled double-blinded trials (n = 345) were identified from searches of MEDLINE, EMBASE and the Cochrane Controlled Trials Register databases. The summary effect size and 95% confidence intervals (95% CI) were calculated by a weighted mean difference analysis using a random-effects model. ⋯ Urine volume did not change significantly at any time. There was therefore a clinically unimportant transient reduction in renal function. NSAIDs should not be withheld from patients with normal preoperative renal function because of concerns about postoperative renal impairment.
-
Anaesth Intensive Care · Dec 1999
Randomized Controlled Trial Comparative Study Clinical TrialA prospective randomized clinical assessment of a new pigtail central venous catheter in comparison with standard alternatives.
The Cook Pigtail central venous catheter (CVC) has been designed to diminish the risk of vascular perforation and consequent cardiac tamponade. With the participation of 12 consultant anaesthetists and 19 registrars, adults undergoing elective surgery were randomized to receive either a Pigtail (n = 101) or their consultant anaesthetists' "standard" CVC (n = 102). Median ease of insertion was rated 8 for Pigtail CVCs and 9 for standards (10 being best; P = 0.001). ⋯ No significant difference was found in insertion time or radiographically assessed tip depth for standard and Pigtail central venous catheters. A perforated right atrium of uncertain cause occurred in a patient who received an Arrow triple-lumen central venous catheter. Participating consultant anaesthetists preferred their "standard" central venous catheter for routine use, but five indicated that they would select a Cook Pigtail where long-term use was planned because of in vitro evidence of its greater safety.