Anaesthesia
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Clinical Trial
Use of the Combitube for airway maintenance during percutaneous dilatational tracheostomy.
The Combitube airway allows short-term ventilation during cardiopulmonary resuscitation and can be useful in the management of the difficult airway. In a prospective observational study we assessed its use during percutaneous dilatational tracheostomy (PDT). Twenty-one intensive care patients scheduled for elective PDT had their tracheal tube replaced by a Combitube airway retaining the same ventilator settings. ⋯ A high mean (SD) transmural pressure of 14.7 (5) kPa was exerted by the distal cuff. The Combitube provided a satisfactory alternative airway to the tracheal tube during performance of PDT in 85% of our patients. Potential problems associated with its use in intensive care patients are outlined.
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Randomized Controlled Trial Clinical Trial
The effect of ketamine pretreatment on propofol injection pain in 100 women.
A controlled, randomised double-blind study was performed to compare the prior intravenous administration of ketamine 10 mg (1 ml) or 0.9% saline (1 ml) on propofol injection pain. One hundred patients of ASA status 1 or 2 presenting for gynaecological surgery were studied. Following an initial 5-ml bolus of propofol into a dorsal hand vein, 30 s after the treatment, 84% of the saline control patients experienced mild or severe pain compared to 26% of those who were given ketamine pretreatment (p < 0.05).
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We report a case of Streptococcus salivarius meningitis following combined spinal-epidural analgesia for labour. Although rare, bacterial meningitis following combined spinal-epidural anaesthesia is being increasingly described. We review the previously reported cases and discuss the possible aetiological causes and the aseptic precautions likely to reduce the incidence of infectious complications.
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Five hundred members of the Obstetric Anaesthetists Association were surveyed regarding their technique for identification of the epidural space. Eighty-one per cent of the questionnaires were returned completed. Fifty-nine per cent of respondents first learned a loss of resistance to air technique, 33.4% to saline and 7.4% another technique. ⋯ Twenty-eight per cent taught a loss of resistance to air, 57.2% taught a loss of resistance to saline and 12.9% taught both techniques. Twenty-three per cent changed from a loss of resistance to air, to a saline technique, and 4.2% vice versa. Forty-seven per cent of those using air felt that loss of resistance to air was not associated with a clinically significant difference in the incidence of accidental dural puncture compared with saline.
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A spreadsheet model of a circle breathing system and a 70-kg anaesthetised 'standard man' has been used to simulate the first 20 min of low-flow anaesthesia with halothane, enflurane, isoflurane, sevoflurane and desflurane in oxygen. It is shown that, with the fresh-gas flow set initially equal to the total ventilation and the fresh-gas partial pressure to 3 MAC, the end-expired partial pressure can be raised to 1 MAC in 1 min with desflurane and sevoflurane, 1.5 min with isoflurane, 2.5 min with enflurane and 4 min with halothane. Sequences of lower fresh-gas flow and partial pressure settings are given for then maintaining 1 MAC end-expired partial pressure, with a minimum usage of anaesthetic, e.g. 13 ml of liquid desflurane in 20 min (of which only 33% is taken up by the patient) if the minimum acceptable flow is 11.min-1, or 8 ml (with 57% in the patient) if the minimum is 250 ml.min-1.