Canadian journal of anaesthesia = Journal canadien d'anesthésie
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The safe, expeditious conduct of ambulatory surgical care can succeed only by careful selection of patients and procedures, appropriate intra- and postoperative anaesthetic management, and safe, timely discharge of patients. Discharge of patients should be achieved without compromising the quality of patient care. As the patients presenting for ambulatory surgery become more complex and compromised, and their surgical treatment more demanding, it is important to replace, or at least supplement, our existing qualitative, subjective method for evaluating patient discharge with a quantitative, objective technique to provide a simple and consistent method of determining home readiness. ⋯ Reduction in the length of stay in an ambulatory surgery unit by the prompt and safe discharge of patients can help to reduce costs and improve unit efficiency. For certain surgical procedures, ambulatory treatment is cheaper, even allowing for treatment failures and readmissions. However, we must remember that the application of any discharge criteria scoring system must include common sense, clinical judgment, and home-readiness of an outpatient does not assume street fitness.
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Meta Analysis Comparative Study
The advantages of the LMA over the tracheal tube or facemask: a meta-analysis.
A meta-analysis was performed on randomised prospective trials comparing the laryngeal mask airway (LMA) with other forms of airway management to determine if the LMA offered any advantages over the tracheal tube (TT) or facemask (FM). Of the 858 LMA publications identified to December 1994, 52 met the criteria for the analysis. Thirty-two different issues were tested using Fisher's method for combining the P values. ⋯ Disadvantages over the TT were lower seal pressures and a higher frequency of gastric insufflation. The only disadvantage compared with the FM was that oesophageal reflux was more likely. The importance of these findings in terms of patient outcome could not be determined from the published data.
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Randomized Controlled Trial Comparative Study Clinical Trial
Edrophonium requirements for reversal of deep neuromuscular block following infusion of mivacurium.
Mivacurium is a new non-depolarizing muscle relaxant consisting of three stereoisomers. The two active isomers (cis-trans and trans-trans) undergo rapid metabolism by plasma cholinesterase (t1/2 beta < 2 min). Due to its rapid elimination, the need for reversal of mivacurium-induced neuromuscular block is controversial, and to date there have been no studies evaluating reversal of deep blocks. ⋯ Two patients (PLAC group), had dibucaine numbers and cholinesterase levels consistent with an EUEA genotype, whereas the two patients with delayed recovery in the EDR-1 group had characteristics of a normal genotype. We conclude that a very low dose of edrophonium (0.125 mg.kg-1) hastens reversal of deep mivacurium-induced neuromuscular block by approximately four minutes, and that edrophonium doses exceeding 0.125 mg.kg-1 provide no additional benefit. Heterozygous patients with atypical plasma cholinesterase levels, as well as certain individuals with normal dibucaine numbers and plasma cholinesterase activity, are at risk for prolonged neuromuscular block, but the block is easily reversed with edrophonium.
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Randomized Controlled Trial Comparative Study Clinical Trial
Oral clonidine premedication reduces vomiting in children after strabismus surgery.
This is a prospective randomized double-blind trial conducted to determine whether preoperative orally administered clonidine causes or potentiates postoperative vomiting in 140 children (3-12 yr) undergoing strabismus surgery. They were all inpatients and classified randomly into four groups (n = 35 each); placebo (control), diazepam 0.4 mg.kg-1, clonidine 2 micrograms.kg-1, and clonidine 4 micrograms.kg-1. These agents were administered 93-112 min (mean; 100 min) before the anticipated time of induction of anaesthesia. ⋯ However, low-dose clonidine was ineffective. These data suggest that preanaesthetic medication with clonidine 4 micrograms.kg-1 may be useful for preventing emesis following strabismus surgery. This property of clonidine indicates that it may be superior to other sedative premedicants such as diazepam and midazolam.
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Randomized Controlled Trial Comparative Study Clinical Trial
The triple airway manoeuvre for insertion of the laryngeal mask airway in paralyzed patients.
The efficacy of the triple airway manoeuvre (mouth opening, head extension and jaw thrust) for insertion of the laryngeal mask airway (LMA) was compared with the standard insertion method. One hundred paralyzed patients were allocated randomly into two groups: in the control group (n = 50) the LMA was inserted by the standard method, and in the other (TAM group, n = 50) by the triple airway manoeuvre. In ten patients of each group, the position of the LMA and the epiglottis was assessed radiographically before insertion, after insertion but before cuff inflation, and after cuff inflation. ⋯ After cuff inflation the glottis was completely visible fibreoptically in 66% in the TAM group, compared with 14% in the control group (P < 0.001). Complete downfolding of the epiglottis was seen in 10% in the control group and none in the TAM group (P < 0.05). We conclude that in paralyzed patients LMA insertion with the triple airway manoeuvre provides wider pharyngeal space and decreases the incidence of epiglottic downfolding by the LMA compared with the standard method.