Anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of epidural infusions of fentanyl or pethidine with bupivacaine in the management of postoperative pain.
A double-blind randomised clinical trial was undertaken in 40 patients undergoing major abdominal surgery. Postoperative pain relief was provided using epidural infusions of 0.06% bupivacaine with fentanyl 4 micrograms.ml-1 (n = 20) (group F) or with pethidine 1.5 mg.ml-1 (n = 20) (group P). Postoperative pain scores using a visual analogue scale (0-100 mm) were not significantly different between the two groups. ⋯ Nine patients were withdrawn from the study (four from group F, five from group P) due to failure of the epidural technique or other complications. Fourteen patients, equally distributed, required a total of 24 epidural 'top-ups' by an anaesthetist because of inadequate analgesia. We demonstrated no advantage with epidural pethidine over fentanyl when used by infusion in combination with bupivacaine in the management of postoperative pain.
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Randomized Controlled Trial Comparative Study Clinical Trial
Topical lignocaine and thiopentone for the insertion of a laryngeal mask airway; a comparison with propofol.
We assessed conditions for insertion of a laryngeal mask airway in 90 unpremedicated adult patients who received either thiopentone 5 mg.kg-1 preceded by 40 mg of topical lignocaine spray to the posterior pharyngeal wall or propofol 2.5 mg.kg-1 alone in a randomised, single-blinded trial. All patients received fentanyl 1 microgram.kg-1. ⋯ The decrease in systolic and diastolic blood pressure, following induction and the insertion of a laryngeal mask with propofol was significantly greater than following thiopentone (p < 0.05--systolic, p < 0.01--diastolic). We conclude that thiopentone preceded by topical lignocaine spray provides conditions for insertion of a laryngeal mask equal to those of propofol, with more haemodynamic stability and a shorter period of apnoea.
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We have measured the brightness (luminance) of the light spot produced by 105 Macintosh 3 laryngoscope blades (33 bulb, 72 fibrelight) using a Hagner photometer. An estimate of the minimum luminance required for laryngoscopy (circa. 100 cd.m-2), was determined using a laryngoscope adapted to provide a variable light output. ⋯ In total, 61 (84%) of the fibrelight blades and three (9%) of the bulb blades were found to provide a light spot that encompassed areas of luminance below 30 cd.m-2, which is a level for comfortable reading. The light spot from a mains-powered fibreoptic bronchoscope was found to be four times brighter (2000 cd.m-2) than a new battery-powered fibrelight laryngoscope.
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The rôle of an anaesthetic incident reporting programme in improving anaesthetic safety was studied. The programme had been running for 4 to 5 years in three large hospitals in Hong Kong and more than 1000 incidents have been reported. The number of reports being made and frequency of the various categories of incident reported, did not alter during the study period. ⋯ The programme was effective in its ability to detect latent errors in the anaesthesia system and when these were corrected, incidents did not recur. The frequency with which various contributing factors were cited did not decrease with time. With the exception of problems dealt with by specific protocol development, the study found no evidence that an increasing awareness of the problem of human error was effective in reducing this kind of problem.