Anaesthesia and intensive care
-
Anaesth Intensive Care · Feb 1996
Randomized Controlled Trial Comparative Study Clinical TrialAnalgesia for acute musculoskeletal trauma: low-dose subcutaneous infusion of ketamine.
Low-dose ketamine by subcutaneous infusion (0.1 mg/kg/h) was compared in double-blind fashion with intermittent morphine (0.1 mg/kg intravenously, four-hourly) as analgesic regimen in 40 ASA-I adults after acute musculoskeletal trauma. Pain was assessed using visual analogue scales and sedation was graded on a four point rank drowsiness score. Objective cardiovascular and respiratory parameters and patient acceptability in terms of supplementary analgesia and early mobilization were also recorded. ⋯ None of the patients in ketamine group required supplementary analgesia (P < 0.001) and the patients could be easily mobilized for traction/splintage as compared with patients in the control group (P < 0.001). The incidence of nausea and vomiting in the morphine group was high (P < 0.01). The study shows that subcutaneous infusion of ketamine provides safe and effective analgesia in acute musculoskeletal trauma.
-
Anaesth Intensive Care · Feb 1996
Comparative Study Clinical Trial Controlled Clinical TrialRocuronium bromide in dental day case anaesthesia--a comparison with atracurium and vecuronium.
We have compared intubating conditions at 60 seconds, onset times and reversal characteristics of the new steroidal nondepolarizing muscle relaxant rocuronium with atracurium and vecuronium. A dose of approximately 1.75 X ED90 of each agent was used to assess their relative suitability for brief day case dental procedures requiring intubation. The anaesthetic technique included propofol, fentanyl, nitrous oxide/oxygen and isoflurane. ⋯ The duration of action of rocuronium was shorter than either atracurium or vecuronium, times for spontaneous recovery to 75% block being 22.2 min, 29.6 min and 26.3 min respectively. The neostigmine evoked recovery indices were rocuronium 4.2 min, atracurium 6.6 min and vecuronium 3.7 min. Maximum blockade of greater than 97% was achieved with all three relaxants.
-
Anaesth Intensive Care · Feb 1996
Comparative StudyPercutaneous dilational tracheostomy--a clinical study evaluating two systems.
Percutaneous dilational tracheostomy (PDT), first described in the 1950s, has become a common bedside technique in the Intensive Care Unit (ICU). This study compares the early complications associated with the use of the Ciaglia PDT (Cook Critical Care, Bloomington, USA) technique, with the newly available Portex PDT technique (Portex Ltd., UK). The Ciaglia technique was adopted in this ICU in July 1994 and twenty-nine patients had a tracheostomy using this set until January 1995. ⋯ The first routine tracheostomy tube change at day 7 was complicated in four cases in the Ciaglia group. One infected stoma was noted in the Ciaglia group at day 7. Both techniques result in rapid, safe placement of a tracheostomy tube in critically ill patients in the ICU, obviating the need for surgical referral and transport to the operating room.
-
The New South Wales Special Committee Investigating Deaths Under Anaesthesia classified 1503 deaths before full recovery from anaesthesia occurring between 1984 and 1990. 172 deaths were attributed to anaesthesia, including 11 in which the anaesthetic choice or management could not be criticized. In the remaining 161 an average of 1.8 errors per case were identified, the most frequent being inadequate preparation of the patient (in 72 cases), inadequate postoperative care (52 cases), the technique of anaesthesia chosen (44 cases) and overdose (43 cases). ⋯ Urgent non-emergency cases, 10% of the 1503 cases classified, constituted 26% of those deaths attributed to anaesthesia. One death attributable to anaesthesia occurred per 20,000 operations and the rate of such deaths was 0.44 per 100,000 population per annum.