Anaesthesia
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Randomized Controlled Trial Clinical Trial
Thoracic epidural analgesia started after cardiopulmonary bypass. Adrenergic, cardiovascular and respiratory sequelae.
The effects of thoracic epidural analgesia started after cardiopulmonary bypass were studied on the subsequent adrenergic, cardiovascular and respiratory responses. Sixteen cardiac surgical patients received either a standardised general anaesthetic (control group) or a standardised general anaesthetic and thoracic epidural analgesia (epidural group). The epidural catheter was sited before surgery and heparinisation. ⋯ Postoperative respiratory function was less impaired in the epidural group, with higher forced expiratory volume in 1 s, forced vital capacity and peak expiratory flow (p < 0.05). Pain scores were also significantly lower in the epidural group (p < 0.05). There were no significant differences in cardiovascular parameters.
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Randomized Controlled Trial Clinical Trial
The effects of single-handed and bimanual cricoid pressure on the view at laryngoscopy.
The effects of two different methods of cricoid pressure on laryngoscopic view were studied in 94 healthy women presenting for routine gynaecological surgery. Laryngoscopy was performed with either single-handed or bimanual cricoid pressure; after grading of the view obtained, the other method was used and second grading performed. Laryngoscopic view was better with the bimanual than with the single-handed technique (p = 0.016). ⋯ Age, weight, Mallampatti score and thyromental distance did not differ between patients in these three groups. Bimanual cricoid pressure should be the initial technique of choice during rapid sequence induction but, in a minority of cases, switching to a single-handed technique may improve the laryngoscopic view. The technique of cricoid pressure which produces the best laryngoscopic view in an individual patient cannot be predicted from the physical features studied.
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Randomized Controlled Trial Comparative Study Clinical Trial
New agents, the circle system and short procedures.
Sevoflurane, desflurane and isoflurane were compared using a circle system in 97 patients undergoing short surgical procedures. Using initial high flows, the time intervals to equilibration between inspired and end-expired agent concentrations were measured; equilibration was defined as FE/FI = 0.8. ⋯ After equilibration total flow were reduced to 500 ml.min-1; at these flows the initial decline in end-expired agent concentration was minimal with desflurane, intermediate with sevoflurane and greatest with isoflurane. Both desflurane and sevoflurane are appropriate for efficient use of the circle system during short anaesthetics.
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Clinical Trial
A new combined spinal-epidural apparatus: measurement of the distance to the epidural and subarachnoid spaces.
A new combined spinal-epidural anaesthesia apparatus with a 27G lockable spinal needle was used in 151 patients. Two groups could be created, based on whether dural perforation was felt or not (group 1: with dural click; group 2: no dural click). Measurements of the epidural space depth and of the protrusion of the spinal needle from the epidural needle (tip-to-tip distance) were made. ⋯ Four patients felt paraesthesia during placement of the spinal needle and, in another four patients, aspiration was necessary to detect cerebrospinal fluid. Two patients needed epidural top-ups due to insufficient level of anaesthesia. The lockable spinal needle provides safe and stable conditions during injection and a high rate of success in reaching the subarachnoid space.
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The outcome of patients admitted to intensive care after a cardiac arrest was determined by reviewing intensive care unit records at four hospitals for 1993 and 1994. Of the 112 patients identified, 49 survived intensive care of whom 28 were discharged from hospital. In January 1996, 26 of the 28 patients could be traced; 22 of these were still alive. ⋯ In intensive care the factors were the presence of reactive pupils (p < 0.01), Glasgow Coma Score (p < 0.001), APACHE II score (p < 0.05), arterial standard bicarbonate (p < 0.05) and the use of inotropes (p < 0.05). It was not possible to use individual variables to predict outcome at the time of intensive care unit admission. The results suggest that neurological function is an important determinant of outcome and more sensitive neurophysiological testing might be a useful prognostic tool.