Anaesthesia
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Clinical Trial Controlled Clinical Trial
Assessment of neuromuscular block at the thumb and great toe using accelography in infants.
We assessed neuromuscular block at the thumb and great toe using accelography after the administration of vecuronium in infants. Train-of-four stimuli were simultaneously applied to the ulnar and tibial nerves using cutaneous electrodes. Anaesthesia was maintained with nitrous oxide (66%) in oxygen and sevoflurane (1%). ⋯ The times from maximal block to 25% recovery of twitch height at the thumb and great toe were 46 (9.1) min and 45 (9.0) min, respectively. The reversal time from 25% to 75% of the train-of-four ratio after the administration of neostigmine was 136 (49.1) s. We conclude that neuromuscular monitoring of the great toe in infants may be a suitable alternative when the thumb is inaccessible.
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The aim of this study was to assess whether passive smoking affected the frequency of airway complications in children undergoing general anaesthesia. One hundred and twenty-five children undergoing general anaesthesia for elective daycase surgery were monitored for adverse respiratory events and desaturation during induction, intra-operatively and in the recovery room. Oxygen saturation was monitored throughout and a venous sample was taken for estimation of carboxyhaemoglobin levels. ⋯ This was related to the cumulative number of cigarettes smoked by individuals to whom the child was exposed (p < 0.05). Neither carboxyhaemoglobin levels nor domiciliary address were predictive of desaturation. This study suggests that passive smoking contributes to postoperative arterial oxygen desaturation following general anaesthesia in children.
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Randomized Controlled Trial Clinical Trial Controlled Clinical Trial
Cricoid pressure: are two hands better than one?
One hundred and twenty patients were studied to compare the view of the larynx at laryngoscopy with one- or two-handed cricoid pressure applied. A blinded crossover technique was employed. When the grade of laryngeal view achieved with either type of cricoid pressure was compared using a 4-point scale there was no significant difference. ⋯ A two-handed technique has been advocated to improve intubation conditions when cricoid pressure is required. It has several disadvantages, its efficacy has not been proven and this study suggests it does not improve the view at laryngoscopy. Two-handed cricoid pressure should no longer be advocated unless an advantage over one-handed cricoid pressure can be shown.
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Randomized Controlled Trial Clinical Trial
Propofol infusion anaesthesia and the immune response in elderly patients undergoing ophthalmic surgery.
In our earlier studies, propofol infusion anaesthesia increased the percentage of T helper cells in middle-aged surgical patients undergoing minor or major surgery. In the present study we compared the effects of total intravenous propofol anaesthesia and combined isoflurane anaesthesia on the immune response to ophthalmic surgery in elderly patients. Twenty patients (median age 75 years, ASA 2-3) were randomly allocated to receive total intravenous propofol anaesthesia (median total dose of propofol 710 mg) or combined isoflurane anaesthesia (median end-expiratory concentration of isoflurane 0.45 vol %). ⋯ The immune response to ophthalmic surgery was basically similar in both anaesthetic groups. The percentage of T helper cells in the blood circulation increased in the propofol group (p < 0.05) but not in the isoflurane group. The difference in the time-response profile for T helper cell percentages between the groups was also statistically significant (p < 0.01).
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Comparative Study
A comparison of retrospective versus contemporaneous nausea scores with patient-controlled analgesia.
In the search for an effective method of reducing the incidence of postoperative nausea, a standardised system of patient assessment is required. We examined 76 patients who had undergone elective total abdominal hysterectomy and were receiving patient-controlled analgesia with morphine. Nausea scores were obtained using an 11-point rating score. ⋯ Maximum contemporaneous score showed greater agreement with the retrospective score than did the median, mean, or minimum contemporaneous score. Collectively, these results suggest that patients tend to remember their episodes of nausea vividly, even if these episodes were punctuated by relatively nausea-free periods. The variability between the two sets of results suggests that contemporaneous and retrospective nausea scores should not be used interchangeably.