Anaesthesia
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Randomized Controlled Trial Clinical Trial
The EMLA patch--a new type of local anaesthetic application for dermal analgesia in children.
The skin application of EMLA cream under a Tegaderm dressing was compared in children with a new combined dressing/local anaesthetic patch--the EMLA patch. The analgesic effect during venepuncture was assessed using a visual analogue scale (patients) and a verbal rating scale (investigator). Skin adhesiveness and incidence of local skin reactions with the two types of application were also studied. ⋯ Only mild local skin reactions (with paleness in the anaesthetised skin area) were observed in both groups. It was concluded that both the EMLA patch and the Tegaderm/EMLA cream dressing provide effective dermal analgesia for venepuncture with a 0.8 mm (outer diameter) cannula. The two types of application were indistinguishable but the ease of application of the patch is a distinct advantage.
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Multicenter Study
The use of the laryngeal mask airway by nurses during cardiopulmonary resuscitation. Results of a multicentre trial.
A multicentre study was undertaken to assess the potential value of the laryngeal mask airway when inserted by ward nurses during resuscitation as a method of airway management, prior to the arrival of the Advanced Life Support Team with tracheal intubation capability. The nurses underwent a training programme agreed by all the participating hospitals and followed an identical protocol and data recording system. One hundred and thirty nurses were trained and 164 cases of cardiac arrest were studied. ⋯ Regurgitation of gastric contents occurred before airway insertion in 20 cases (12%), during the insertion in three cases (2%), but there was clinical evidence of pulmonary aspiration in only one patient, who survived to leave hospital. We conclude that the laryngeal mask airway offers advantages over other methods of airway and ventilation management, such as the bag-valve-mask or mouth-to-mouth methods that are currently used by ward nurses in resuscitating patients with cardiac arrest. In this study, the laryngeal mask airway was not being compared with the tracheal tube.
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A case of life-threatening respiratory distress during a Caesarean section under spinal anaesthesia is reported. Possible causes of the event including anaphylactoid reactions and the methods of their diagnosis are discussed. The most likely cause of the episode was felt to be an anaphylactoid reaction to Syntocinon.
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The uptake rate of oxygen and nitrous oxide were studied during low flow anaesthesia with enflurane or isoflurane in nitrous oxide with either spontaneous or controlled ventilation. The excess gas flow and composition were analysed. The nitrous oxide uptake rate was in agreement with Severinghaus' formula VN20 1000.t-0.5. ⋯ The equation assumes constant inspired gas concentrations of 30% oxygen and 65-70% nitrous oxide. The oxygen uptake rates calculated from this formula were in good agreement with measured uptake rates. Thus, continuous monitoring of oxygen uptake rates is possible by using only reliable flowmeters and analysis of inspired oxygen concentration.
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We collected data on postoperative nausea and vomiting from 3850 patients aged 11-91 years. Thirty-seven percent of the 3244 patients who received a general anaesthetic reported nausea and 23.2% vomited. Twenty percent of the 606 patients who received a local anaesthetic reported nausea and 11.4% vomited. ⋯ Anxiety before general, but not local, anaesthesia was associated with postoperative nausea (p < 0.001) but not vomiting. Patients from the gynaecological, orthopaedic, ENT and general surgical wards had higher incidences of postoperative nausea and vomiting. Linear visual analogue pain scores were higher in patients with postoperative nausea and vomiting in both general and local anaesthesia groups (p < 0.001).