Anaesthesia
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In recent years there has been a growing awareness of the possible hazards caused by anaesthetic gases in operating theatres. The laryngeal mask airway provides an alternative both to tracheal intubation and the face mask although the implications for operating theatre contamination have not been quantified. This paper describes the incidence and magnitude of exposure of theatre personnel to waste anaesthetic gases during laryngeal mask airway anaesthesia. ⋯ All patients were anaesthetised with propofol, alfentanil and nitrous oxide. There was no statistically significant association between the amount of anaesthetic gas leakage and ventilation method. The laryngeal mask airway meets occupational safety requirements on nitrous oxide concentrations in the operating theatre environment.
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Randomized Controlled Trial Comparative Study Clinical Trial
A multiple dose comparison of combinations of ibuprofen and codeine and paracetamol, codeine and caffeine after third molar surgery.
In a randomised, double-blind, double-dummy, multiple dose, crossover study in 30 patients we compared an ibuprofen/codeine combination (400 mg ibuprofen/25.6 mg codeine phosphate) with a paracetamol/codeine/caffeine combination (1 g paracetamol/16 mg codeine phosphate/60 mg caffeine) for pain relief over 6 days after two-stage bilateral lower third molar removal. The ibuprofen combination produced significantly greater analgesia than the paracetamol combination, both on single-dose analysis of the first and second days and on multiple-dose measures for days 1, 2, 3 and 4. ⋯ This trial design (crossover with multiple dosing in outpatients) is a sensitive way of testing for analgesia, and is potentially more predictive of adverse effect problems than single-dose studies. It confirms that multiple dosing may show increased efficacy.
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Clinical Trial
Mivacurium chloride: a study to evaluate its use during propofol-nitrous oxide anaesthesia.
We assessed the neuromuscular and cardiovascular effects of mivacurium chloride, a neuromuscular blocking agent, in 33 patients during propofol-nitrous oxide anaesthesia. Neuromuscular function was assessed with supramaximal stimuli of the ulnar nerve, using surface electrodes at the wrist, with repeat trains of four. Mivacurium given as a bolus of 0.15 mg.kg-1 (ED95 x 2) was found to be haemodynamically stable. ⋯ Following a bolus it took a mean (SD) of 26.2 (3.7) min for the fourth twitch of the train of four (T4):T1 ratio to reach 0.7. In patients receiving an infusion with spontaneous offset it took a mean (SD) time of 12.0 (2.2) min to reach the T4:T1 ratio of 0.7 from a T1:TC value of 8.8. Edrophonium significantly decreased the recovery time in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)
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The predicted outcome of anaesthesia and surgery was compared with the immediate outcome in 508 patients by means of two 100 mm linear analogue scales. The results were used to obtain a statistically based rule by which the anaesthetist may consistently select three groups of patients for audit: group 1, patients in whom immediate outcome of anaesthesia and surgery is worse than predicted; group 2, patients whose outcome is better than predicted; and group 3, the remaining patients. The rule, which is simply adapted to departmental audit, does not necessarily need a computer but is suited to the computer as it is numerically based.