Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Randomized Controlled Trial Clinical Trial
Perioperative administration of caffeine tablets for prevention of postoperative headaches.
Interruption of daily caffeine consumption can cause caffeine withdrawal headache. As headache ranks among the most frequent minor postoperative sequelae, the impact of perioperative substitution of caffeine on the incidence of postoperative headache was evaluated. Forty patients undergoing minor surgical procedures with general anaesthesia were randomly allocated to receive either placebo or caffeine tablets at a dosage equal to their individual average daily caffeine consumption. ⋯ Ten patients (50%) who received placebo reported headaches, which persisted in seven patients (35%) until the next day. No patient receiving caffeine substitution therapy reported headache following surgery, and only one complained of headache on postoperative day 1. We suggest that the prophylactic administration of caffeine tablets might be considered for surgical patients who are accustomed to a high daily intake of caffeine.
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Comparative Study Clinical Trial Controlled Clinical Trial
Effects of calcium channel blockers on circulatory response to tracheal intubation in hypertensive patients: nicardipine versus diltiazem.
We studied the circulatory responses to laryngoscopy and tracheal intubation in 37 hypertensive patients who received nicardipine 30 micrograms.kg-1 iv (Group N, n = 12), diltiazem 0.3 mg.kg-1 (Group D, n = 12) or saline placebo (Group C, n = 13) 60 sec before the initiation of laryngoscopy. Anaesthesia was induced with thiopentone 5 mg.kg-1 iv, and succinylcholine 2 mg.kg-1 iv was used to facilitate tracheal intubation after precurarization with vecuronium 0.02 mg.kg-1 iv. ⋯ The increase in MAP following tracheal intubation in Groups N and D was lower than that in Group C (P < 0.05). We conclude that, compared with nicardipine, administration of diltiazem iv is associated with less circulatory response to tracheal intubation in hypertensive patients.
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Randomized Controlled Trial Comparative Study Clinical Trial
Post-tonsillectomy infiltration with bupivacaine reduces immediate postoperative pain in children.
Pain management after tonsillectomy in children remains a dilemma for the anaesthetist. A previous study demonstrated that the administration of lidocaine 1% topical spray to the peritonsillar fossae before tracheal extubation provided considerable immediate postoperative pain relief in infants and children. However, the pain relief was of short duration. ⋯ Peritonsillar infiltration of bupivacaine provided superior immediate postoperative analgesia as reflected by lower recovery room pain scores (P < 0.05) and opioid requirements (P < 0.01). Ward pain scores and analgesic requirements were similar among groups. Peritonsillar infiltration of bupivacaine 0.5% with 1:200,000 epinephrine provides better post-tonsillectomy pain control in the immediate postoperative period than bupivacaine spray or placebo.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of percutaneous and operative tracheostomies in intensive care patients.
The aim of our study was to compare the complication rate of convenional surgical and percutaneous dilational tracheostomies performed under general anaesthesia in critically ill patients. Fifty-three consecutive patients whose lungs were mechanically ventilated and who required tracheostomy were randomised to undergo either conventional surgical tracheostomy (n = 28) in the operating room or percutaneous dilational tracheostomy (n = 25) in the intensive care unit under general anaesthesia. All of the procedures were successfully completed. ⋯ In the surgical tracheostomy group, there were two patients with cuff leaks, one with a stomal infection and one with a pneumothorax. None of these complications occurred after percutaneous, dilational tracheostomy. We conclude that the low incidence of complications in both groups indicates that percutaneous dilational tracheostomy can be performed as safely in the intensive care unit with general anaesthesia as surgical tracheostomy can be performed in the operating room.
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Clinical Trial
Lightwand intubation: II--Clinical trial of a new lightwand for tracheal intubation in patients with difficult airways.
Lightwands have been used to assist in the tracheal intubation of patients with difficult airways for many years. A new lightwand (Trachlight) with a brighter light source and a flexible stylet permits both oral and nasal intubation under ambient light. This study reports the effectiveness of the Trachlight in tracheal intubation in patients with difficult airways. ⋯ The tracheas of these two patients were intubated successfully using a fibreoptic bronchoscope. Orotracheal intubation was successful in all patients in Group 2 using the Trachlight with a mean (+/- SD) time-to-intubation of 19.7 +/- 13.5 sec. Apart from minor mucosal bleeding (mostly from nasal intubation), no serious complications were observed in any of the study patients.(ABSTRACT TRUNCATED AT 250 WORDS)