Anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Combined epidural/spinal anaesthesia for caesarean section. Through the needle or in separate spaces?
An evaluation of a 30 gauge spinal needle in a combined epidural/spinal anaesthetic technique for Caesarean section revealed a 25% failure rate of the spinal element. In this unit, no more than 4% of spinal anaesthetics might be expected to fail. One of the reasons for the higher failure rate was that, when using the Tuohy needle as an introducer, the dura was not identified. ⋯ One hundred women requiring elective Caesarean section under spinal anaesthesia were randomised into single or double space groups. The technique failed in 16% of through-the-needle cases, and in 4% of sequential sitings. Combined spinal/epidural anaesthesia for Caesarean section is more successful if each procedure is performed using separate spaces.
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The reported incidence of hoarseness following short-term tracheal intubation varies widely. It has been reported as being permanent in 3%. This suggests that an enormous problem exists considering the numbers of patients intubated daily in the United Kingdom. ⋯ Those who were hoarse for 54 and 99 days had vocal cord granulomata. Regression analyses showed that certain patient and anaesthetic factors had a significant effect on the hoarseness. This study confirms a low incidence of prolonged or permanent hoarseness following short-term tracheal intubation.
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Comparative Study
Appropriate use of local anaesthetic for venous cannulation.
A departmental survey indicated that the large majority of anaesthetists believed that injection of local anaesthetic before insertion of an intravenous cannula was unnecessary if a cannula of 18 gauge or smaller was used, because injection of local anaesthetic would be more painful than insertion of the cannula. A study was undertaken to test this hypothesis. The results showed that intravenous cannulation with a cannula of 18, 20 or 22 gauge was significantly (p less than 0.006) more painful than a subcutaneous injection of 1% lignocaine. We recommend that subcutaneous injection of local anaesthetic should be considered before insertion of any size of intravenous cannula.
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The outcome of adult respiratory distress syndrome complicating cardiopulmonary bypass has changed little in recent years. A retrospective, case-controlled study was designed to assess the incidence of the adult respiratory distress syndrome in these circumstances and the extent to which it could be linked with pre and peri-operative predictive factors. ⋯ Significant predictors were a high intra and postoperative intervention score, the total volume of blood pumped during bypass (greater than 300 l) and age (greater than 60 years). These risk factors should alert the clinician to the possibility of severe postoperative pulmonary complications.