Anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial Controlled Clinical Trial
A jet nebuliser for delivery of topical anesthesia to the respiratory tract. A comparison with cricothyroid puncture and direct spraying for fibreoptic bronchoscopy.
Topical anesthesia of the respiratory tract for fibreoptic bronchoscopy was compared, in a single-blind study, inhaled from a simple and inexpensive jet nebuliser, administered by cricothyroid injection or by a 'spray-as-you-go technique'. Each technique was supplemented by spraying lignocaine through the fibrescope and intravenous fentanyl-droperidol sedation. Inhaled nebulisation was successfully used for 96% (46 of 48) of patients, was safe, effective and acceptable to the patient and bronchoscopist. ⋯ The nebuliser technique is as satisfactory as the spraying technique in patients for diagnostic bronchial lavage in whom bleeding from a cricothyroid puncture is unacceptable. Patients who used the nebuliser were more satisfied. This technique may also be a useful method for 'awake' intubation.
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Randomized Controlled Trial Clinical Trial
Local application of EMLA and glyceryl trinitrate ointment before venepuncture.
One hundred unpremedicated fit day surgery patients aged between 27 and 68 years were allocated randomly into one of four groups and EMLA, glyceryl trinitrate, EMLA and glyceryl trinitrate or a placebo ointment was applied to the dorsum of a hand. The pain and ease of venepuncture were determined at induction of anaesthesia 60 minutes later. Pain scores were also reassessed 1-2 hours after operation. Lower pain scores and easier venepuncture occurred when EMLA and glyceryl trinitrate ointment was applied to the dorsum of the hand.
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Randomized Controlled Trial Clinical Trial
Tussive effect of a fentanyl bolus administered through a central venous catheter.
One hundred and ten male patients scheduled for coronary artery bypass grafting were allocated randomly into one of three groups. Patients in group A received fentanyl 7 micrograms/kg via a central venous catheter, those in group B were given fentanyl 7 micrograms/kg through a peripheral venous cannula, and patients in group C received sterile water via a central venous catheter. ⋯ Only one patient in group B and no patient in the control group exhibited a cough response (p less than 0.0001). We hypothesise that fentanyl can evoke the pulmonary chemoreflex.
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Two patients with dystrophia myotonica presented for urgent Caesarean section. Their per- and postoperative courses illustrate the anaesthetic problems posed by this disease. ⋯ Choice of anaesthetic agent is discussed. Both had general anaesthetics; muscle relaxation was achieved with vecuronium.
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Pre-existing subglottic stenosis in a 22-month-old child with laryngotracheobronchitis resulted in failure to intubate the trachea on the intensive therapy unit. Tracheostomy was necessary in the operating theatre to secure the airway. The implications for safe management are discussed.