Anaesthesia
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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.
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Randomized Controlled Trial Clinical Trial
Learning fibreoptic skills in ear, nose and throat clinics.
We have compared the progress of anaesthetists taught fibreoptic techniques on awake patients in ear, nose and throat clinics with that of anaesthetists taught by traditional methods. Twelve anaesthetists participated in the study and were randomly allocated to the ear, nose and throat group or to the traditional training group. Each individual in the ear, nose and throat group attended the outpatient clinic and performed ten nasendoscopies on awake patient, whose upper airway had been anaesthetised with cocaine, under the supervision of an ear, nose and throat surgeon. ⋯ To assess the effectiveness of the two training methods, each anaesthetist in each group then attempted ten fibreoptic nasotracheal intubations on anaesthetised oral surgery patients. There was no significant difference between either the success rates or mean successful tracheoscopy times between the two groups. Nasendoscopy training in the ear, nose and throat clinic appears to be good way of learning fibreoptic skills, which can then be readily applied to fibreoptic tracheal intubation in anaesthetic practice.
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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.
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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.
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An analysis of 1500 laryngeal mask airway uses by one anaesthetist using the standard insertion technique was conducted to determine successful insertion rates, position by fibreoptic larynoscopy, complication rates and whether there is a long-term learning curve. The correlation between laryngeal mask airway placement and modified Mallampati grade was also determined. The first time insertion rate was 95.5% with an overall failure rate after three attempts of 0.4%. ⋯ The vocal cords were visible from the mask aperture bars in 97.1%. Comparison of insertion rates, fibreoptic position and complications for the first and second 750 insertions provides evidence for a 'long' term learning curve. These data could be used as a guide for 'optimal' or expected successful laryngeal mask airway insertion rates in adults undergoing routine anaesthesia.