Anaesthesia
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Randomized Controlled Trial Clinical Trial
Teaching fibreoptic intubation. Effect of alfentanil on the haemodynamic response.
A technique for teaching fibreoptic orotracheal intubation in patients under general anaesthesia is described and evaluated. A standard general anaesthetic was administered to 60 patients presenting for elective gynaecological surgery. Patients were randomly assigned to receive either alfentanil 10 micrograms.kg-1 or a placebo, and to be intubated either by a consultant experienced in the use of the fibreoptic bronchoscope or by an inexperienced trainee under instruction. ⋯ The hypertensive response to fibreoptic intubation was suppressed in those patients who received alfentanil (p < 0.001). The increase in heart rate was not suppressed, but was attenuated when these patients were compared with those who had received the placebo (p < 0.001). Alfentanil 10 micrograms.kg-1 minimises the haemodynamic response when teaching fibreoptic orotracheal intubation under general anaesthesia.
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Comparative Study
The effect of insufflation leaks upon ventilation. A quantified comparison of ventilators.
Some ventilator-dependent patients use uncuffed tracheostomy tubes, resulting in fluctuations in the minute volume of ventilation. Bedside measurement of ventilation is difficult because of the insufflation and exsufflation leaks. This laboratory study of five different ventilators measured the tidal volumes achieved with three insufflation leaks introduced in an increasing order of magnitude and at three levels of compliance. ⋯ The turbine-driven pressure-limited ventilator retained a peak pressure of 20.5 cmH2O and lost only 14% of the volume, whereas the volume ventilators lost 65% of the tidal volume. The loss of volume was 3% for every cmH2O decrease in airway pressure due to a leak, regardless of the ventilator or compliance. Using the Friedman test, the differences between the volume ventilators and the pressure ventilators were significant whilst the three pressure-limited ventilators did not perform significantly differently from each other.
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Randomized Controlled Trial Comparative Study Clinical Trial
Intra-operative patient-controlled sedation and patient attitude to control. A crossover comparison of patient preference for patient-controlled propofol and propofol by continuous infusion.
Intra-operative patient controlled sedation with propofol (bolus dose 18 mg over 5.4 s; lockout period 1 min) has been compared to continuous propofol infusion (3.6 mg.kg-1.h-1) in a randomised crossover study of 38 ASA 1 or 2 day surgery patients undergoing two-stage bilateral extraction of third molar teeth under local anaesthesia (76 procedures). Mean (SD) propofol used (mg.kg-1) was less with patient-controlled sedation (2.39 (1.28) than with the infusion (2.58 (0.84)) but the difference was not statistically significant. There were only minor differences between the methods in postoperative recovery of cognitive function and no differences for patient cooperation and surgeon's satisfaction with sedation. ⋯ Sedation was no deeper than eyelid closure with response to command in all 76 procedures. This level was reached in all 38 infusion cases but in only 26 cases with patient-controlled sedation, where 12 patients remained less sedated (p < 0.01). Patient-controlled sedation with propofol provided safe sedation and was strongly preferred over the infusion by a large proportion of patients.
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Randomized Controlled Trial Clinical Trial
Teaching fibreoptic intubation in anaesthetised patients.
One hundred ASA grade 1 and 2 patients requiring orotracheal intubation for various general surgical procedures were randomly assigned to receive either expert rigid laryngoscopic or novice fibreoptic orotracheal intubation under total intravenous anaesthesia. Five anaesthesia residents in the 4th year, with no prior experience in fibreoptic laryngoscopy, participated in a fibreoptic training course, viewing two instructional videos and practising on the intubation manikin. Each resident intubated 20 patients in a randomised fashion either as an expert laryngoscopist or as a fibreoptic novice. ⋯ The haemodynamic profile was similar for fibreoptically intubated and conventionally intubated patients and there was no difference between the first two or the last two fibreoptic or rigid intubations. The study was designed to detect a difference of 10% in means (assuming alpha = 0.05 and beta < or = 0.2). The incidence of postoperative sore throat, dysphagia or hoarseness was similar in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)