Anaesthesia and intensive care
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Anaesth Intensive Care · Dec 1997
Randomized Controlled Trial Comparative Study Clinical TrialA comparison of sevoflurane with halothane for paediatric day case surgery.
A phase III, open label randomized study was conducted in 50 patients comparing halothane and sevoflurane for paediatric day case surgery. A graded inhalational induction resulted in only slightly more rapid induction with sevoflurane (3.34 +/- 0.92 versus 3.85 +/- 1.02 minutes; P > 0.05). In children receiving sevoflurane, systolic blood pressure decreased to a lesser extent during induction (143 +/- 19.2 versus 26.9 +/- 10.9 percent decrease from resting values; P < 0.01) and heart rate was maintained. ⋯ Objective pain/discomfort scores were higher in patients receiving sevoflurane at 10, 20, 30 and 40 minutes after arrival in the recovery room, and the incidence of excitement during emergence was higher in this group. It is concluded that sevoflurane is well tolerated for inhalational induction and has an improved cardiovascular profile compared to halothane. Emergence was significantly more rapid following sevoflurane.
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Anaesth Intensive Care · Dec 1997
Review Comparative StudyOpioid requirements and responses in Asians.
The provision of good analgesia can be influenced by ethnic differences in how pain is expressed, the attitudes of patients and health professionals towards pain management and pharmacological differences in the responses to opioids. It is difficult to generalize results so that they are applicable to any ethnic group as a whole. There is also the question of how best to categorize ethnic Asians who have been in Australasia for several generations. ⋯ An individualized pain management program is essential for any patient, whatever his or her ethnic origin. The use of patient-controlled analgesia will minimize some of the problems that may occur because of poor communication between the patient and the healthcare staff. Nevertheless, in a multicultural society like Australia's, health professionals should be conscious of the many factors that may influence the effects of prescribed treatment to manage pain in different ethnic groups.
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Anaesth Intensive Care · Dec 1997
Comparative StudyObjective evaluation of the difficulty of endotracheal intubation. A comparative study of two different laryngoscope blades.
A method for objective evaluation of the difficulty of endotracheal intubation is described. Our data indicate that the angle formed by the light-beam axis of the laryngoscope blade and the laryngotracheal axis, which we call "angle phi", is analogous to the degree of difficulty of endotracheal intubation. Using this method, we compared the effectiveness of a standard Macintosh and a modified bevelled Macintosh blade in 27 tracheostomized Intensive Care Unit patients under general anaesthesia. Statistical analysis of our results indicate that the bevelled blade significantly facilitates endotracheal intubation.
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Anaesth Intensive Care · Dec 1997
Case ReportsInhalational induction with sevoflurane in an adult with severe complex central airways obstruction.
Sevoflurane is a newly available volatile anaesthetic agent which is suitable for inhalational induction of anaesthesia. Due to concerns about obstructing the upper airway as anaesthesia deepens, its use has until now been avoided in patients with upper airway obstruction. We used its smooth induction and recovery properties however to anaesthetize a patient with central airway obstruction and coexistent ischaemic heart disease. Sevoflurane proved to be a very satisfactory agent in this situation.
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Anaesth Intensive Care · Dec 1997
Case ReportsHypoglossal neuropraxia following endotracheal intubation.
A case of hypoglossal nerve neuropraxia following elective drainage of bilateral chronic subdural haematomas is described. We postulate that the cause of neuropraxia was inadvertent extubation of the trachea with the cuff inflated, leading to compression and stretch of the nerve against the greater horn of the hyoid bone. The literature on cranial nerve palsies following endotracheal intubation is reviewed.