Anaesthesia
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Randomized Controlled Trial Clinical Trial
The SMART needle. A new Doppler ultrasound-guided vascular access needle.
Central venous access is an essential part of patient management in many clinical settings. Traditionally this has been achieved by a blind, external landmark guided technique which may not correlate exactly with the location of the vessel. We have prospectively evaluated the SMART needle, a new Doppler ultrasound guided vascular access device, in 40 patients, to evaluate whether it can improve on the standard technique. ⋯ No advantage was demonstrated in 'easy' internal jugular vein cannulations. Although ease of cannulation in difficult cases was subjectively improved, the differences in time to cannulation and number of passes between the groups failed to reach statistical significance and the complication rates were similar. However, the use of the SMART needle on two occasions enabled avoidance of carotid artery puncture by correctly distinguishing the artery from the vein, so that it may have a rôle in patients in whom difficult internal jugular venous cannulation is anticipated.
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A retrospective study of admissions to a Level 1 Trauma Centre, revealed 393 patients with traumatic cervical spine injuries. All 36 patients intubated urgently and 37 and 68 patients intubated between 30 min and 24 h of admission, were intubated orally, following a rapid sequence induction with the application of cricoid pressure and manual in-line stabilisation of the head and neck. ⋯ This technique for airway management is described in detail. It is a safe, familiar, and effective method for securing the airway in patients with cervical spine injury.
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Randomized Controlled Trial Comparative Study Clinical Trial
Acid aspiration prophylaxis in elective biliary surgery. A comparison of omeprazole and famotidine using manually aided gastric aspiration.
We have compared the effects of single oral doses of omeprazole 40 mg, famotidine 40 mg or placebo on gastric secretion in 45 non-obese patients the night before elective biliary surgery. After stable anaesthesia had been established, a Salem orogastric tube was introduced and gastric contents were aspirated by a blinded observer. The volume and pH were noted. ⋯ Patients were considered to be at risk if pH < 2.5 and volume > 0.4 ml.kg-1. Three patients in the omeprazole group, three in the placebo group and none in the famotidine group came into this category. We conclude that a single oral dose of omeprazole 40 mg given the night before surgery does not afford adequate prophylaxis for acid aspiration syndrome.
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Randomized Controlled Trial Clinical Trial
The oesophageal detector device. An assessment of accuracy and ease of use by paramedics.
Accuracy, ease and speed of recognition of tracheal tube position were assessed using the oesophageal detector device in a series of 40 tests on 29 patients. A single blind method was used, with each paramedic performing a single test on each patient. The tests were randomly split between two groups consisting of those tests performed on the tracheal or oesophageal tube respectively. ⋯ Each paramedic also graded speed of recognition of position and ease of use of the device. Recognition of position was graded as instant in 37 out of 40 tests. Use of the oesophageal detector device by previously inexperienced paramedics has thus been shown to be accurate, rapid and easy to learn.
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Bench testing was carried out to establish whether the vapour output from an OMV50 vaporizer, as used in the Triservice apparatus, differs according to whether the carrier gas is either drawn or pushed through the vaporizer. Results show that the differences in output concentration between the two modes were clinically insignificant.