Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Awake intubation using the Bullard laryngoscope can be comfortably and easily performed in the adult. Five cases are presented in which tracheal intubation was performed under topical anaesthesia with light intravenous sedation. ⋯ In one case, Bullard intubation was successful where direct laryngoscopy and multiple attempts at bronchoscopic intubation by three different operators had failed. We conclude that the Bullard laryngoscope can be easily used in awake patients and may be a useful alternative where other methods for awake intubation have failed.
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Randomized Controlled Trial Comparative Study Clinical Trial
Regional anaesthesia for hernia repair in children: local vs caudal anaesthesia.
The purpose of this study was to compare the effect of local anaesthesia (LA) with that of caudal anaesthesia (CA) on postoperative care of children undergoing inguinal hernia repair. This was a randomized, single-blind investigation of 202 children aged 1-13 yr. Anaesthesia was induced with N2O/O2 and halothane or propofol and maintained with N2O/O2/halothane. ⋯ The LA-patients had a shorter recovery room stay (40 +/- 9 vs 45 +/- 15 min, P < 0.02). The postoperative stay was prolonged in the CA group (176 +/- 32 vs 165 +/- 26 min, P = 0.02). We conclude that LA and CA have similar effects on postoperative care with only slight differences.
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Randomized Controlled Trial Clinical Trial
Nondepolarizing neuromuscular blocking drugs and train-of-four fade.
The aim of this study was to examine differences in prejunctional effects of different relaxants by measuring the train-of-four (TOF) fade during the onset and recovery of neuromuscular block. The relaxants studied were atracurium (225 micrograms.kg-1), mivacurium (65 micrograms.kg-1) rocuronium (300 micrograms.kg-1) and vecuronium (40 micrograms.kg-1). ⋯ Although there was a slightly greater fade with atracurium and rocuronium during the onset of block, the differences among the relaxants were insignificant. It is concluded that the relative prejunctional effects of these relaxants are similar.
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Randomized Controlled Trial Clinical Trial
Midazolam reduces vomiting after tonsillectomy in children.
The purpose of this study was to assess the effect of midazolam on vomiting after tonsillectomy in children. We compared 215 children aged 1.5-14 yr undergoing tonsillectomy or adenotonsillectomy under general anaesthesia with nitrous oxide and halothane. In a double-blind fashion the subjects were administered either placebo or midazolam 75 micrograms.kg-1 iv after induction of anaesthesia. ⋯ The 108 midazolam-treated children had a lower incidence (42% vs 57%) of vomiting than the placebo group, P < 0.02. The placebo group had a higher incidence (9% vs 2%) of unscheduled admissions to hospital due to nausea and vomiting, P < 0.05. It is concluded that midazolam administered intravenously to children intraoperatively reduces vomiting after tonsillectomy.
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Comparative Study
Withholding and withdrawing life-sustaining therapy in a Canadian intensive care unit.
The purpose of this study was to document the rationale and procedures for withholding and withdrawing life-sustaining treatment in critically ill patients. A prospective observational study was conducted over 12 mo in a Canadian academic intensive care unit. Of the 110 intensive care unit patients who died during the study period, 71 (64.5%) died after treatment was withheld or withdrawn. ⋯ There was a consistent approach to withdrawing therapy in 68 of the 71 patients who had treatment either withheld or withdrawn. In these 68 patients, the first step was to write a do-not-resuscitate order, vasopressor drugs were then stopped and, lastly, the patient was weaned from mechanical ventilation and the trachea was extubated. The results of this study demonstrate that life-supporting treatment is commonly withdrawn in critically ill patients when continued therapy is thought to be unlikely to restore the patient to health.