Anaesthesia
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Randomized Controlled Trial Clinical Trial
The analgesic efficacy of tenoxicam versus placebo in day case laparoscopy: a randomised parallel double-blind trial.
The analgesic efficacy and duration of action of tenoxicam, an injectable non-steroidal analgesic with a long elimination half-life, were studied in day case laparoscopy in a double-blind randomised prospective parallel placebo-controlled trial. Tenoxicam 20 mg or saline was given intravenously at induction of anaesthesia in 67 women undergoing day case investigative laparoscopy for infertility or abdominal pain. ⋯ The study showed no statistically significant difference in any of these measures between the two groups. Tenoxicam 20 mg intravenously immediately pre-operatively cannot be recommended for day case surgery on the basis of this study.
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Randomized Controlled Trial Clinical Trial
Evaluation of the contribution to postoperative analgesia by local cooling of the wound.
Thirty healthy patients undergoing lumbar spine surgery were randomly assigned to one of two groups for postoperative pain relief. Group 1 received morphine via patient controlled analgesia and local cooling of the wound by an externally applied cooling pad while group 2 received patient controlled analgesia alone. There was a significant reduction in morphine consumption when local cooling was applied (18.6 mg versus 30.2 mg at 12 h, 29.0 mg versus 49.6 mg at 24 h, p < 0.05). Patients were also significantly more satisfied with their overall postoperative pain management when cooling therapy was used.
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Randomized Controlled Trial Clinical Trial
Nasotracheal tube placement over the fibreoptic laryngoscope.
We have assessed the effectiveness of three tracheal tube rotational movements in assisting nasotracheal tube placement over the fibreoptic laryngoscope. Ninety ASA grade 1 or 2 oral surgery patients undergoing fibreoptic nasotracheal intubation under general anaesthesia were studied. After the fibrescope had been positioned in the trachea, patients were randomly allocated to one of three groups. ⋯ If resistance to the advance was encountered, up to two more attempts were allowed, after further rotational manoeuvres had been made, in accordance with a standard, graduated sequence. There were significantly more successful tube placements at the first attempt in groups 2 and 3 (93% and 100% respectively) than in group 1 (63%). It is therefore recommended that 90 degrees anticlockwise or overcorrected 90 degrees anticlockwise tube rotation is used to facilitate nasotracheal tube placement during fibreoptic intubation.
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We report the case of a 48-year-old woman, referred to the Intensive Care Unit with community-acquired pneumonia, who was noted to have stridor of acute onset. Subsequent indirect laryngoscopy revealed bilateral abductor vocal cord paralysis, secondary to unsuspected carcinoma of the oesophagus, requiring immediate tracheostomy. We highlight the importance of visualisation of the vocal cords in cases of stridor of uncertain aetiology.
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A fit 27-year-old man presented with severe facial trauma following an industrial accident. Initial assessment showed severe swelling around the lower jaw and haemorrhage from the mouth, nose, scalp and left ear. The patient was conscious with a Glasgow Coma Score of 13 but in respiratory distress. ⋯ Relief of the patient's airway obstruction was a priority and the patient underwent awake fibreoptic intubation in the prone position prior to induction of anaesthesia. Computed tomography scans of his head and neck were unremarkable and after fixation of a bilateral mandibular fracture he made an uneventful recovery. Intubation in the semi-prone position may be a useful technique in injuries of this type.