Anaesthesia
-
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.
-
Guidelines for cardiac anaesthesia could reduce irrational variation in practice and so improve cardiac surgical outcome. In October 1994, a postal survey was undertaken to determine the views and attitudes of consultant cardiac anaesthetists in the United Kingdom towards guidelines. ⋯ Responses to other parts of the questionnaire showed that those against guidelines for cardiac anaesthesia were less positive towards their advantages and more negative to their disadvantages compared with those in their favour. The majority of cardiac anaesthetists, although believing them to be valuable in medicine, do not want guidelines for cardiac anaesthesia because they are concerned that guidelines would be inflexible and would neither reduce variation in, nor improve the quality of, cardiac anaesthesia.
-
Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of remifentanil and alfentanil in patients undergoing major abdominal surgery.
The efficacy and safety of remifentanil and alfentanil for patients undergoing major abdominal surgery were compared. Premedicated patients received a loading dose of remifentanil (1.0 microgram.kg-1; n = 116) and a continuous infusion of 0.5 microgram.kg-1.min-1, or a loading dose of alfentanil (25 micrograms.kg-1; n = 118) and a continuous infusion of 1.0 microgram.kg-1.min-1. Propofol was administered (10 mg every 10 s) until loss of consciousness. ⋯ In patients undergoing major abdominal surgery, remifentanil appears to offer superior intra-operative haemodynamic stability during stressful surgical events compared with alfentanil without compromising recovery from anaesthesia. Remifentanil can be administered as a postoperative analgesic agent at a starting dose of 0.1 microgram-.kg-1.min-1; however, it should only be used in the presence of adequate supervision and monitoring of the patient. Administration of bolus doses is not recommended in this setting.