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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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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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.
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Randomized Controlled Trial Comparative Study Clinical Trial
Dexmedetomidine as intramuscular premedication for day-case cataract surgery. A comparative study of dexmedetomidine, midazolam and placebo.
The effects of dexmedetomidine 1.0 microgram.kg-1, midazolam 20 micrograms.kg-1 and saline placebo were assessed in a double-blind, randomised study in 90 patients undergoing day-case cataract surgery under regional anaesthesia. The trial drug was injected into the deltoid muscle 45 min before the peri-ocular block. Dexmedetomidine 1.0 microgram.kg-1 decreased intra-ocular pressure before, during and after surgery. ⋯ Dexmedetomidine and midazolam produced a similar sedative effect of short duration. Dexmedetomidine induced a moderate decrease in blood pressure (p < 0.001 compared with placebo) and a slight but statistically significant decrease in heart rate throughout the study period (p < 0.001 compared with placebo). Dexmedetomidine 1.0 microgram.kg-1 intramuscularly, effectively reduced intra-ocular pressure and produced short-acting sedation with marginal cardiovascular effects; it may be a useful premedicant drug for elderly patients undergoing day-case cataract surgery under regional anaesthesia.