Anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Simulated difficult intubation. Comparison of the gum elastic bougie and the stylet.
A randomised study was carried out to compare the efficacy of the gum elastic bougie and the stylet in a simulated difficult intubation. A laryngoscopic assessment, as described by Cormack and Lehane, was made in 100 patients. A Grade 3 view was then simulated. ⋯ In the Stylet First Group (50 patients) the order was reversed. After two attempts the tube was correctly placed in the trachea in 96% of cases in the Bougie First Group compared to only 66% of cases in the Stylet First Group (p < 0.001). We recommend that a gum elastic bougie should be readily available and that anaesthetists should use it in preference to a stylet whenever a good view of the glottis is not immediately available.
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We have evaluated the Sonomatic Confirmation of Tracheal Intubation device (SCOTI) by testing its ability to be correctly configured with a variety of tracheal tubes of differing internal diameter and length. The device only configured correctly for RAE tubes with internal diameter of 7.0 mm or greater and for armoured tubes of internal diameter 8.5 mm. For conventional tubes of varying internal diameter cut to different lengths, configuration was only successful with certain dimensions. The inability to configure the device correctly with all types and lengths of tracheal tubes limits its usefulness as a indicator of tracheal intubation.
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Biography Historical Article
Did the use of chloroform by Queen Victoria influence its acceptance in obstetric practice?
Examination of contemporaneous publications suggests that the use of chloroform by Queen Victoria in 1853 did not result in the major breakthrough in the acceptability of obstetric anaesthesia with which the event has been credited by some later writers.
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Randomized Controlled Trial Comparative Study Clinical Trial
Neuromuscular and cardiovascular advantages of combinations of mivacurium and rocuronium over either drug alone.
We investigated isobolic mixtures of mivacurium and rocuronium to determine if the combination offered any advantages over either drug alone. We used five dose regimens to achieve ED95 x 2: [(1.5 x ED95 mivacurium) + (0.5 x ED95 rocuronium); (1 x ED95 mivacurium) + (1 x ED95 rocuronium); (0.5 x ED95 mivacurium) + (1.5 x ED95 rocuronium); (2 x ED95 mivacurium); (2 x ED95 rocuronium)]. We studied onset time, duration of block, recovery of block, arterial blood pressure and heart rate. ⋯ Onset time was shortest in the rocuronium alone group and was significantly faster in all the rocuronium treated groups compared to mivacurium alone (p < 0.001). Arterial blood pressure and heart rate decreased transiently in the mivacurium alone group but not in the other groups. These results demonstrate increased cardiovascular stability and more rapid onset of block with combinations of mivacurium and rocuronium without significant prolongation of the block.
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Randomized Controlled Trial Clinical Trial
The effect of epidural opioids on maternal oxygenation during labour and delivery.
The effects of epidural fentanyl on the incidence of maternal hypoxaemia during labour and on neonatal welfare were examined. Women were randomly allocated to receive one of two epidural infusions, bupivacaine 0.125% alone or bupivacaine 0.0625% with 2.5 micrograms.ml-1 fentanyl, and maternal arterial oxygen saturation was monitored continuously until delivery. ⋯ Similarly, the incidence of desaturation to SpO2 < or = 90% was greater in the fentanyl group than in controls (p = 0.02). There was no correlation between maternal oxygenation or plasma fentanyl concentration and neonatal welfare as measured by umbilical arterial and venous blood gas and acid base status, Apgar score and Neurologic and Adaptive Capacity Score.