Anaesthesia
-
Continuous noninvasive blood pressure measurement is of great potential use in the critically ill. This study was designed to find out whether measurements of blood pressure by a Finapres accurately represented intra-arterial pressure. ⋯ There was an unpredictable but usually stable difference between measurements from the two sources; this difference varied in magnitude and direction in individual patients. At present the Finapres cannot be recommended as a substitute for intra-arterial blood pressure measurement in the critically ill.
-
Two pre-operative tests for the prediction of difficult intubation are assessed. A modified Mallampati test and a measurement of thyromental distance were performed at the pre-operative visit of 244 patients whose tracheas were subsequently intubated under general anaesthesia. Patients in whom the posterior pharyngeal wall could not be visualised below the soft palate, who also had a distance of less than 7 cm between the prominence of the thyroid cartilage and the bony point of the chin proved significantly more likely to present difficulty with intubation. The performance of these two simple tests on all patients before operation should allow the majority of cases of difficult intubation to be anticipated.
-
Randomized Controlled Trial Comparative Study Clinical Trial
The effect of a priming epidural injection of adrenaline on epidural blockade with bupivacaine.
Twenty-four patients receiving epidural anaesthesia were studied to test the hypothesis that 1:200,000 adrenaline administered into the epidural space 5 minutes before 20 ml bupivacaine 0.5% would improve nerve block and delay systemic absorption of the local anaesthetic. Group A/B received 20 ml adrenaline 1:200,000 5 minutes before 20 ml bupivacaine 0.5%, group S/BA 20 ml saline followed by 20 ml bupivacaine 0.5% with 100 micrograms adrenaline, and group S/B saline 20 ml followed by 20 ml plain bupivacaine 0.5%. ⋯ In both adrenaline groups a more prolonged epidural block and increased efficacy were noted, although this was only significant for the duration of block at T6 (p = 0.023) and duration of motor block at Bromage level 1 (p = 0.016) in group A/B. There seems little clinical advantage in administering adrenaline 5 minutes before bupivacaine.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Effect of prior administration of cold saline on pain during propofol injection. A comparison with cold propofol and propofol with lignocaine.
A single-blind, randomised, controlled study was undertaken to compare the efficacy of three methods of preventing pain during injection of propofol on induction of anaesthesia. Patients were allocated randomly to receive unmodified propofol, propofol with 0.05% lignocaine, propofol at 4 degrees C and unmodified propofol preceded by 10 ml of 0.9% saline at 4 degrees C. Prior injection of cold saline reduced the incidence of pain and discomfort significantly (22%) compared with unmodified propofol (75%; p less than 0.005) and was similar to that after cold propofol (33%) and propofol with lignocaine (44%). There was no significant difference between the treatment groups.
-
Randomized Controlled Trial Clinical Trial
Gastric emptying following caesarean section and the effect of epidural fentanyl.
The rate of absorption of paracetamol following oral administration was used as an indirect measure of the rate of gastric emptying. This was to determine the effect on gastric motility of the addition of fentanyl to a solution of local anaesthetic given into the epidural space to provide pain relief following Caesarean section. ⋯ The area under the curve of the graph of plasma paracetamol concentration versus time was calculated for each subject at 45 and 90 minutes after administration of the epidural injection, and this value was used as an index of the rate of gastric emptying. This study demonstrated that gastric emptying may be normal immediately following Caesarean section under epidural anaesthesia, but that if fentanyl is added to the epidural solution, gastric emptying is significantly slower in the first 45 minutes following surgery (p less than 0.05).