Anaesthesia
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Randomized Controlled Trial Clinical Trial
The cardiovascular responses to double lumen endobronchial intubation and the effect of esmolol.
The cardiovascular responses to double lumen endobronchial intubation and the effect of esmolol were examined in two groups of 10 ASA 2 & 3 patients undergoing pulmonary surgery in a double blind, placebo-controlled study. Endobronchial intubation was associated with a significant increase in arterial pressure and heart rate (p = 0.004), and a significant increase in plasma noradrenaline concentrations (p < 0.01) in the control group. ⋯ The increase in plasma noradrenaline concentrations was significantly greater (p < 0.05) in the esmolol group. The pressor response to endobronchial intubation in this study was of a similar magnitude to that known to occur in response to tracheal intubation.
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Despite common clinical opinion that patient-controlled analgesia should be renamed 'patient-controlled nausea', there is little evidence in support of the notion that postoperative nausea and vomiting are exacerbated by the method. Indeed, data indicate that opioid-sparing techniques are not associated with less postoperative nausea and vomiting. Although some evidence suggests that certain opioids are less emetogenic than others, this too does not stand scrutiny when compared across patients, although research is still required to find whether individual patients are better treated with a particular opioid. Similarly, the emerging practice of combining anti-emetics with patient-controlled analgesia needs wider study before it can be supported.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of the nasal mask and the nasopharyngeal airway in paediatric chair dental anaesthesia.
This study compared the quality of anaesthesia and surgical access afforded by two techniques for the administration of anaesthesia during paediatric chair dental procedures. A total of 50 ASA 1 paediatric day case patients were randomly assigned to receive anaesthesia through either the traditional Goldman nasal mask or through a nasopharyngeal airway. ⋯ Operating conditions were universally graded as excellent in the nasopharyngeal airway group, while those in the nasal mask group were graded as excellent/good in only 79% of cases (p < 0.0001). These results suggest that better quality anaesthesia and operating conditions can be achieved by using a nasopharyngeal airway rather than the traditional nasal mask for the administration of anaesthesia to paediatric chair dental patients.
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A patient with a previous surgical history of a cleft lip and palate repair and a pharyngeal flap pharyngoplasty was admitted for repair of mandibular prognathism. Following induction of anaesthesia, it was impossible to advance the nasotracheal tube into the oropharynx. Using a dental mirror and retrograde tracheal intubation equipment, under direct vision, the nasotracheal tube was finally advanced into the oropharynx.