Anaesthesia
-
The triggering of phantom limb pain by subarachnoid or epidural anaesthesia has been well described leading to the suggestion that neuraxial regional anaesthesia is relatively contraindicated in lower limb amputees. We report our experience of the provision of anaesthesia for repeat Caesarean section on two occasions in such a patient. Intrathecal fentanyl and morphine supplementation of bupivacaine successfully abolished peri-operative phantom limb pain, whereas epidural anaesthesia was associated with recurrence of phantom limb pain upon regression of the block.
-
The amount of desflurane required to maintain an end-expired concentration of 8% was measured in 30 ASA 1 and 2 patients undergoing elective spinal surgery. The anaesthetic was administered using a computer-controlled closed circle system. After an initial period during which the expired concentration of desflurane was stabilised (4 min) the rate of uptake showed a bi-exponential decline. Mean cumulative usage of desflurane was 10.1 ml of liquid at 30 min, 14.8 ml at 60 min, 25.4 ml at 120 min, 35.8 at 180 min.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Anaesthesia for day-care arthroscopy. A comparison between desflurane and isoflurane.
A study was undertaken to compare desflurane- and isoflurane-based anaesthesia in patients undergoing day-care arthroscopic surgery. Anaesthesia was induced with propofol 2-3 mg.kg-1 and a laryngeal mask airway was inserted after loss of the eyelash reflex. Patients were then randomly divided into two groups to receive maintenance anaesthesia with either isoflurane or desflurane delivered in oxygen and nitrous oxide. ⋯ The mood adjective checklist showed that patients in the isoflurane group had a greater total mood score and were more calm than those in the desflurane group; this was particularly evident 2 h after anaesthesia. The discharge times were similar for the two groups. Desflurane is a satisfactory alternative to isoflurane for day care anaesthesia.
-
Randomized Controlled Trial Clinical Trial
The use of the McCoy laryngoscope in patients with simulated cervical spine injuries.
We studied the laryngoscopic view in 167 patients with their head and necks held in the neutral position with manual in-line stabilisation and cricoid pressure to simulate the patient with a suspected cervical spine injury. Each patient underwent laryngoscopy using both a McCoy and a Macintosh laryngoscope. The best view obtained by each larngoscope was graded according to standard guidelines. ⋯ It improved the Macintosh grade by 1 grade in 41% and by 2 grades in 8% (p < 0.001). Difficult laryngoscopy, defined as the inability to see the glottis (grade 3 or 4), was found in 56 (33%) with the Macintosh laryngoscope and only eight (5%) (P < 0.001) with the McCoy laryngoscope. We suggest that patients with a suspected cervical spine injury and a full stomach should be intubated using a McCoy in preference to a Macintosh laryngoscope.