Anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of 25 G and 27 G Whitacre needles for caesarean section.
Spinal needles with a pencil-point tip and those of a finer gauge are known to be associated with a lower incidence of postdural puncture headache. This study set out to determine if fine pencil-point needles were acceptably easy to use in routine clinical practice. Two hundred and twelve women undergoing elective Caesarean section were randomly allocated to receive a subarachnoid block using either a 25 G or 27 G Whitacre needle. ⋯ In the 25 G group, there was one severe postdural puncture headache which required an epidural blood patch and three mild headaches which resolved spontaneously. There were no postdural puncture headaches in the 27 G group. We conclude that the final choice of needle is a compromise between the ease of use and lower failure rate of the 25 G needle and the, as yet unproven, possibility of a lower incidence of postdural puncture headache with the 27 G needle.
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Randomized Controlled Trial Comparative Study Clinical Trial
Peri-operative effect of major gastrointestinal surgery on serum magnesium.
This study investigates the changes in serum magnesium levels after major gastrointestinal surgery and evaluates if Plasma-Lyte 148 used as maintenance fluid influences these changes in the peri-operative period. Thirty patients presenting for procedures ranging from anterior rectal resection to thoraco-abdominal cardio-oesophagectomy were randomly allocated into two groups, one of which received compound sodium lactate solution as the maintenance crystalloid during the intra- and postoperative period, and the other Plasma-Lyte 148, a magnesium-containing crystalloid solution. ⋯ The results showed a statistically significant (p < 0.05) reduction in the magnesium levels in both groups. The reduction was less marked in the Plasma-Lyte group but this did not achieve statistical significance (p > 0.05) compared with the compound sodium lactate group.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparative effects of laryngeal mask and tracheal tube on total respiratory resistance in anaesthetised patients.
We compared the effects of the laryngeal mask and tracheal tube on total respiratory resistance in 10 anaesthetised, mechanically ventilated patients undergoing otological microsurgery. The subjects were randomly divided into two groups. In the first group, the tracheal tube (Rüsch) was inserted for the first series of measurements. ⋯ Although the glottic resistance was included in the measurement performed with the laryngeal mask but not with the tracheal tube, mean (SE) total respiratory resistance was not significantly different with the two devices (0.61(0.32) and 0.69(0.35) kPa.l-1.s, respectively). Leakage was avoided with the laryngeal mask because the insufflation pressure never exceeded 1.7 kPa except in one patient suffering from severe chronic obstructive pulmonary disease who had a total respiratory resistance of 1.45 kPa.l-1.s. During the first hour of the operation all respiratory variables remained stable irrespective of the device used.
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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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Comparative Study Clinical Trial
The effect of laryngoscopy of different cervical spine immobilisation techniques.
Fifty patients underwent laryngoscopy with two different cervical spine immobilisation techniques. First the cervical spine was immobilised in a rigid collar with tape across the forehead and sandbags on either side of the neck, then with an assistant providing manual in-line immobilisation. Finally, patients underwent laryngoscopy in the routine intubating position. ⋯ There was a poor view on laryngoscopy (grade 3 or 4) in 64% of patients when immobilised in a collar, tape and sandbags compared to 22% of patients undergoing in-line manual immobilisation (p < 0.001). Mouth opening was significantly reduced when patients were wearing cervical collars and this was the main factor contributing to the increased difficulty of laryngoscopy in this particular form of cervical spine immobilisation. It is recommended that manual in-line immobilisation should be the method of choice for cervical spine stabilisation during tracheal intubation.