Anaesthesia and intensive care
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Anaesth Intensive Care · Aug 1997
Randomized Controlled Trial Comparative Study Clinical TrialLaryngeal mask insertion following inhalational induction in children: a comparison between halothane and sevoflurane.
The aim of this study was to compare laryngeal mask insertion conditions following inhalational induction with either halothane or sevoflurane. Fifty-eight healthy children scheduled for dental extraction were randomly assigned to receive nitrous oxide 66% in oxygen and 3.0 MAC of either halothane or sevoflurane introduced in a stepwise fashion. The laryngeal masks were inserted when an adequate depth of anaesthesia was attained and the reactions and time to insertion noted. ⋯ The conditions for laryngeal mask insertion were generally good with 86.2% and 89.2% in the halothane and sevoflurane groups respectively having had no reactions to insertion. The complications to laryngeal mask insertion encountered were mild. The emergence time from the anaesthetic was found to be shorter for sevoflurane but the difference was not statistically significant.
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Anaesth Intensive Care · Aug 1997
Continuous extrapleural intercostal nerve block for post thoracotomy analgesia in children.
The safety and efficacy of continuous extrapleural intercostal nerve block has been well established in adults. This review of our initial paediatric experience suggests a role for this technique in children and discusses risks and benefits relative to other forms of regional analgesia for thoracotomy. Nine children aged one to twelve years received extrapleural infusions of bupivacaine 0.1-0.2% following lateral thoracotomy for lung resection. ⋯ Postoperative nausea and vomiting and respiratory depression were not observed in any patient and all were able to comply with physiotherapy. There were no complications of catheter placement or bupivacaine administration. Our initial experience suggests that this is a safe technique which minimizes complementary opioid administration and provides adequate analgesia for children postthoracotomy for lung resection.
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Anaesth Intensive Care · Aug 1997
Tracheostomy in a neuro-intensive care setting: indications and timing.
A retrospective review was made of 49 survivors who were mechanically ventilated for more than 48 hours in the neurosurgical ICU. Thirty-two patients (Gp I) were successfully extubated, 9 patients (Gp II) underwent tracheostomy after one or more failed extubations, and 8 patients (Gp III) underwent elective tracheostomy. Glasgow Coma Scale (GCS) scores at extubation were 11.3 +/- 2.8 (mean (SD) for Gp I vs 7.8 +/- 2.7 for Gp II (P = n.s.) and at elective tracheostomy (Gp III) was 5.4 +/- 2.3. ⋯ Reasons for reintubation in 7 of 9 patients (Gp II) were upper airway obstruction and tenacious tracheal secretions while 14 of 17 patients were weaned off the ventilator within 48 hours of tracheostomy. The length of stay in ICU was 16.8 +/- 7.1 days in Gp II vs 11.7 +/- 2.9 days in Gp III (P < 0.05). In our study, elective tracheostomy for selected patients with poor GCS scores and nosocomial pneumonia has resulted in shortened ICU length of stay and rapid weaning from ventilatory support.