Anaesthesia
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Randomized Controlled Trial Clinical Trial
The oesophageal detector device. Assessment of a new method to distinguish oesophageal from tracheal intubation.
A new method to distinguish oesophageal from tracheal intubation using the oesophageal detector device was evaluated. In 100 healthy adults, observers of differing experience reliably and rapidly detected 51 oesophageal and 49 tracheal intubations in a randomised, single-blind trial. ⋯ This method can be used in patients with bronchospasm to detect correct tracheal placement when auscultation and decreased compliance of the chest may make clinical confirmation difficult. It can be concluded from this study that the oesophageal detector device is a reliable, rapid, inexpensive and easy to use method for the detection of oesophageal intubation and its very low cost should make it readily available in all situations where tracheal intubation is carried out.
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A patient with Klippel-Feil syndrome who underwent abdominal surgery is presented and the anomaly reviewed. The anatomical abnormality and potentially unstable neck provide a potentially difficult tracheal intubation which was undertaken using an awake fibreoptic technique. The role of the fiberscope and the advantage of pre-operative assessment of the difficult airway are discussed.
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The clinical effects and plasma levels associated with the use of 0.5% bupivacaine with and without the addition of 1:200,000 adrenaline (5 micrograms/ml) were studied in 30 patients who underwent extradural anaesthesia for elective Caesarean section. The addition of adrenaline to bupivacaine prolongs analgesia, reduces the degree of hypotension and delays its onset. Plasma bupivacaine levels were consistently lower when adrenaline was added, but this difference was significant only at 10 minutes after the initial dose. Prolonging the interval between increments seems to be a more reliable way to reduce plasma concentration than the addition of the catecholamine.
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An investigation into practices of the epidural services in a regional sample of obstetric units was undertaken following recent reported disasters associated with epidural analgesia for labour pain. A questionnaire was completed by all 22 obstetric units in the region, which included six teaching, 14 district and two independent centres. In three units the epidural service was shared with the obstetricians. ⋯ Midwife in-service training in the initial management of serious epidural complications and in cardiopulmonary resuscitation was inconsistent. In some units, the avoidance of aortocaval compression was not emphasised in the management of serious complications such as severe maternal hypotension, total spinal blockade or cardiac arrest of the parturient. The results obtained in this survey suggest that there is a need to review the requirements in the provision of obstetric epidural services and consideration should be given to the establishment of a generally accepted standard of practice.
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Comparative Study
Isoflurane as an alternative to halothane for caesarean section.
Two series of 25 patients who underwent elective Caesarean section with general anaesthesia were given either 0.75% isoflurane or 0.5% halothane as supplements to 50% nitrous oxide in oxygen used for maintenance. The potent inhalational agent was given for the entire operative period and no case of intra-operative dreaming or awareness was reported. ⋯ The surgeon's assessment of uterine relaxation and bleeding using a visual analogue score indicated that this was significantly less with isoflurane. Infant well-being as judged by Apgar score and cord blood gas analysis, showed little difference between the two inhalational agents.