Anaesthesia and intensive care
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Fifty-three patients presenting for minor gynaecological procedures received caudal blocks performed by residents. These residents used the standard technique which relied on the "give" felt as a needle penetrates the sacrococcygeal membrane and the loss of resistance to air when the needle is correctly placed. The "whoosh" test was noted by the supervising anaesthetist who did not reveal his findings to the residents. ⋯ The predictive value of a positive test was found to be 78%, 80.7% and 97.7% (P < 0.01) for a positive "give", loss of resistance and "whoosh" test respectively. Negative tests had no predictive value for "give" and loss of resistance whilst the predictive value of an absent "whoosh" was 100% (P < 0.05). Thus we conclude that the "whoosh" test is an excellent aid in the teaching of caudal anaesthesia.
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Anaesth Intensive Care · Jun 1993
Randomized Controlled Trial Clinical TrialEpidural catheter insertion: the effect of saline prior to threading in non-obstetric patients.
The effects of injecting normal saline 4 ml through the epidural needle before catheter passage on ease of catheterisation and incidence of certain complications were investigated in 189 non-obstetric patients. The use of saline had no effect on ease of catheterisation, with 84.2% of Group S patients (saline, n = 95) and 88.3% of Group C patients (control, n = 94) having the difficulty of passing the catheter rated as "easy" (P = 0.31). ⋯ Epidural venous cannulation occurred in 6.3% of Group S patients versus 11.7% of Group C patients (P = 0.30). We conclude that the use of 5 ml of normal saline prior to catheter threading provides no significant benefit in improving the ease of catheterisation or decreasing the incidence of catheter complications.
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Anaesth Intensive Care · Jun 1993
Comparative StudyThe Sprotte needle and post dural puncture headache following caesarean section.
One hundred and forty-four patients receiving subarachnoid anaesthesia for caesarean section were prospectively analysed for quality of anaesthesia and the occurrence of post dural puncture headache (PDPH). Anaesthesia was administered via 24 gauge Sprotte (n = 104) and 26 gauge Quincke (n = 40) needles using hyperbaric bupivacaine 0.5% with morphine 0.2 mg. Anaesthesia was successful in 103 patients with the Sprotte needle and 38 patients with the Quincke needle, and the operating conditions were considered to be excellent. ⋯ Of the 40 patients in the Quincke needle group there were eight with PDPH (20%), three of which were considered severe. Despite the lower incidence of headache in the Sprotte needle group, this was not statistically significant (P > 0.05), due to the difference in population size. We conclude that the 24 gauge Sprotte needle is associated with a comparatively low but clinically relevant incidence of headache in the obstetric population.