Anaesthesia
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Comparative Study
Laryngeal mask airway insertion. A comparison of the standard versus neutral position in normal patients with a view to its use in cervical spine instability.
The ease of insertion of the laryngeal mask airway with the patient's head in the standard position and the neutral position was compared, in a study of 80 healthy patients. Successful insertion was assessed by fibreoptic bronchoscopy and the functioning of the airway. ⋯ There were no significant differences in scores as assessed by fibreoptic bronchoscopy. The laryngeal mask airway may have a role in the management of some patients with cervical spine instability, although confirmation of this ultimately depends on the results of outcome studies.
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This study examined the effectiveness of a new type of chest drain, which incorporates an additional lumen within its wall to facilitate the administration of intrapleural bupivacaine. Nine patients who received a bolus dose of 1.5 mg.kg-1 bupivacaine with 1:200,000 adrenaline through this chest drain used less morphine, and had lower visual analogue pain scores in the first 6 h after thoracotomy than patients in whom a standard chest drain had been used. Bupivacaine levels were found to be within safe limits in all patients.
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Case Reports
Cardiorespiratory arrest following combined spinal epidural anaesthesia for caesarean section.
A 31-year-old woman had an elective Caesarean section under combined spinal/epidural anaesthesia. At the end of the operation, diamorphine 2.5 mg in 5 ml of 0.25% bupivacaine plain was injected through the epidural catheter. Forty minutes after this, the patient had a cardiorespiratory arrest in an ordinary postnatal ward.
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Randomized Controlled Trial Comparative Study Clinical Trial
Zingiber officinale (ginger)--an antiemetic for day case surgery.
The effect of powdered ginger root was compared with metoclopramide and placebo. In a prospective, randomised, double-blind trial the incidence of postoperative nausea and vomiting was measured in 120 women presenting for elective laparoscopic gynaecological surgery on a day stay basis. The incidence of nausea and vomiting was similar in patients given metoclopramide and ginger (27% and 21%) and less than in those who received placebo (41%). ⋯ The requirements for postoperative analgesia, recovery time and time until discharge were the same in all groups. There was no difference in the incidence of possible side effects such as sedation, abnormal movement, itch and visual disturbance between the three groups. Zingiber officinale is an effective and promising prophylactic antiemetic, which may be especially useful for day case surgery.