Anaesthesia and intensive care
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Anaesth Intensive Care · Feb 1999
Review Case ReportsSurgical emphysema following percutaneous tracheostomy.
We report two patients in whom a Portex GWDFT was complicated by surgical emphysema. Subsequent examination revealed posterior tracheal wall tears in these patients. The exact aetiology of these tears is unknown, although the tracheostomy tube introducer may have been implicated. We suggest a management plan for this complication.
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Anaesth Intensive Care · Feb 1999
Randomized Controlled Trial Clinical TrialThe effect of midazolam on persistent postoperative nausea and vomiting.
The effect of intravenous midazolam on persistent postoperative nausea and vomiting (PONV) was compared to placebo in a prospective randomized double-blind study. Twenty patients aged 18 to 82 years with persistent PONV resistant to standard anti-emetics and present for greater than six hours were randomized to receive either an intravenous infusion of midazolam 1.0 mg/h or placebo. Nausea (P = 0.04), vomiting (P = 0.02) and the use of rescue anti-emetics (P = 0.003) were significantly less in the midazolam group. We conclude that low-dose intravenous infusion of midazolam significantly reduces persistent PONV.
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Anaesth Intensive Care · Feb 1999
Comparative StudyEpidural analgesia reduces the release of amino acids from peripheral tissues in the ebb phase of the metabolic response to major upper abdominal surgery.
The purpose of this prospective cohort study was to compare metabolic effects of epidural or patient controlled analgesia (PCA) in patients undergoing major upper abdominal surgery. Seventeen patients undergoing major upper abdominal surgery were included: 10 received perioperative epidural analgesia (Group I) and the remainder received morphine via a PCA device for postoperative analgesia (Group II). A number of measures compared between one day preoperatively (day 1) and day 2 postoperatively included femoral arterial and venous blood concentrations of glucose, lactate, pyruvate and amino acids. ⋯ The efflux of glycine, methionine, amino benzoic acid, alanine, and lysine was less in Group I than Group II on day 2 (P < 0.05). There was a significant difference in the total amino acid flux on day 2 (Group I = -1.2 mumol. (100 ml tissue)-1.min-1 cf Group II = -2.5 mumol. (100 ml tissue)-1.min-1; P = 0.04). In conclusion, perioperative epidural analgesia was associated with a reduced postoperative amino acid efflux two days following major upper abdominal surgery.
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Anaesth Intensive Care · Feb 1999
Case ReportsAnaesthesia for caesarean section in a patient with an intracranial arteriovenous malformation.
Intracranial haemorrhage from an arteriovenous malformation (AVM) during pregnancy is rare but may result in significant maternal and fetal morbidity and mortality. In the untreated patient with an AVM, the best mode of delivery remains debatable with most obstetricians preferring a caesarean section in order to avoid Valsalva manoeuvres associated with vaginal delivery. We describe the administration of epidural anaesthesia for such a parturient undergoing Caesarean section and the anaesthetic implications.
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Anaesth Intensive Care · Feb 1999
Prevalence and prediction of difficult intubation in Chinese women.
We conducted a prospective, blind observational study to investigate the prevalence and prediction of difficult intubation in Chinese women. Two groups of Chinese women were studied (151 pregnant and 260 non-pregnant). The prevalence of difficult intubation was 1.99% in the pregnant and 1.54% in the non-pregnant group. ⋯ Predictive variables for difficult intubation, including modified Mallampati class, thyromental distance and atlanto-occipital extension, had high sensitivity but low positive predictive value when used alone. A shorter thyromental distance had to be used as the criterion for prediction in Chinese women. Combination of predictive variables could improve the positive predictive value.