Anaesthesia
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Comparative Study Clinical Trial Controlled Clinical Trial
Cerebral oximetry: a useful monitor during carotid artery surgery.
Cerebral oximetry was evaluated as a monitor of oxygenation during carotid endarterectomy in 22 patients. The oximeter was a reliable continuous monitor, identifying changes in cerebral oxygenation during episodes of hypotension and after arterial occlusion. ⋯ There was no correlation between internal carotid artery stump pressure and change in cerebral oxygenation after application of the arterial cross clamp. However, cerebral oxygenation correlated weakly with the change in middle cerebral artery velocity as measured by transcranial Doppler ultrasonography (r = 0.49, p < 0.02).
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of ondansetron and droperidol in reducing postoperative nausea and vomiting associated with patient-controlled analgesia.
In a randomised, placebo-controlled trial we have compared the efficacy of ondansetron and droperidol in reducing postoperative nausea and vomiting associated with patient-controlled analgesia after orthopaedic surgery. One hundred and forty five patients, ASA 1 and 2, undergoing major orthopaedic surgery were anaesthetised using a standardised technique. They were randomly allocated to receive patient-controlled analgesia as morphine 1 mg.ml-1 alone; morphine as before plus a single dose of 1.25 mg droperidol together with 0.083 mg.ml-1 in the infusion syringe; or morphine as before plus 4 mg ondansetron and 0.13 mg.ml-1 in the syringe. ⋯ The number of patients suffering from nausea alone was not significantly different between the three groups, although those in the ondansetron group experienced less severe nausea (p < 0.05) when using a two point scale. The droperidol group had significantly higher sedation scores than the other two groups (p < 0.005). We conclude that ondansetron is superior to droperidol when used with patient-controlled analgesia and causes less sedation.
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Randomized Controlled Trial Clinical Trial
SCOTI--a new device for identification of tracheal intubation.
A new lightweight device for the detection of placement of a tracheal tube in the trachea or oesophagus is described. The device utilises a sonic technique detecting resonating frequencies in an open (trachea) or closed (oesophagus) structure. Evaluation of the device in a clinical environment is described and it has been shown to be capable of verifying the correct placement of the tracheal tube in the trachea in 98% of patients studied. Further evaluation of this intubating aid appears justified.
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Randomized Controlled Trial Clinical Trial
Pressure support ventilation during isoflurane anaesthesia.
We have studied the respiratory effects of 5 and 10 cmH2O pressure support ventilation during anaesthesia with 1.5% end-tidal concentration of isoflurane in nine healthy, spontaneously breathing, adult patients. Some of the patients demonstrated an irregular respiratory pattern with periods of apnoea and we therefore went on to study a further seven patients with a continuous 500 s recording of airflow. Pressure support ventilation augmented mean (SD) tidal volume from 212 (56) ml to 360 (88) ml at 5 cmH2O and to 509 (108) ml at 10 cmH2O (n = 16, p < 0.05). ⋯ Mean (SD) inspiratory work of breathing decreased from 1.77 (0.70) J. min-1 to 0.31 (0.36) J.min-1 at 5 cmH2O and 0.16 (0.26) J.min-1 at 10 cmH2O pressure support ventilation (n = 9, p < 0.05). Analysis of the respiratory rhythm in the second group of seven patients revealed an oscillating respiratory pattern in four patients at 5 cmH2O and six of the seven patients at 10 cmH2O pressure support ventilation. The metabolic advantage of the decreased work of breathing during pressure support ventilation during anaesthesia is unlikely to balance the disadvantage of an oscillating respiratory rhythm.
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All patients discharged from a general intensive care unit over a 4.5 year period were sent a questionnaire 3 months after discharge which investigated aspects of their health and physical abilities. Replies were compared on the basis of age, diagnosis and sickness severity on admission. Five hundred and four questionnaires were analysed. ⋯ Patients aged 76 years or older were more likely to perceive their health as 'better than average' than younger patients (p < 0.01). Eight percent of patients would be unwilling to undergo intensive care again. An unacceptable health status after intensive care cannot be predicted in any group of patients.