Anaesthesia
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Clinical Trial Controlled Clinical Trial
The best view at laryngoscopy using the McCoy laryngoscope with and without cricoid pressure.
The best view obtained by levering the tip of the McCoy laryngoscope blade with or without modified cricoid pressure was studied in 100 patients presenting for general surgery. The airway was assessed pre-operatively (Mallampati score, thyromental distance, mouth opening, protrusion of the jaw and weight) in an attempt to identify the patients who might benefit from the use of the McCoy laryngoscope. The vocal cords were visible at laryngoscopy with the blade in the neutral position in 32 cases. ⋯ The epiglottis only was seen in 18 patients and in two not even the epiglottis could be visualised. Elevation of the blade or modified cricoid pressure improved the view in 38/68 cases and 57/68 cases, respectively (p < 0.001, Wilcoxon signed rank). Using our method of pre-operative assessment we were unable to identify those patients who might benefit from either manipulation.
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We studied the frequency with which treatment was withdrawn in intensive care patients and the primary reason for reaching the decision. The medical records of patients having had active treatment withdrawn between August 1992 and February 1996 inclusive were reviewed. Patients were classified into an imminent death group consisting of those expected to die, a qualitative group who had treatment withdrawn on quality of life considerations and a lethal conditions group who had associated disease that precluded long-term survival. ⋯ The primary reason for treatment withdrawal was imminent death in 45% of patients, qualitative considerations in 50% and lethal conditions in 5%. The reason varied significantly depending on the patient's age. Treatment is withdrawn commonly in ICU, the primary reason being quality of life considerations as often as because death is the expected outcome.
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Randomized Controlled Trial Clinical Trial
Peribulbar anaesthesia using a mixture of local anaesthetic and vecuronium.
The aim of this double-blind, randomised study was to assess the effects of the addition of 0.5 mg of vecuronium bromide to a standard local anaesthetic mixture used for peribulbar anaesthesia. We studied 60 patients undergoing regional anaesthesia for intra-ocular surgery and were primarily interested in the quality of globe and lid akinesia. ⋯ Eye movements assessed at both 5 and 10 min were significantly reduced in the vecuronium group (group B) (p < 0.05). We conclude that the addition of vecuronium at a dose of 0.5 mg to the standard local anaesthetic mixture improves the quality of globe and lid akinesia.
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Randomized Controlled Trial Clinical Trial
Pouch of Douglas block for laparoscopic sterilisation.
The use of local anaesthetic has been shown to reduce the incidence of pain after laparoscopic sterilisation and the need for opioid analgesia from day surgery. We investigated a technique in which a catheter is placed in the pouch of Douglas allowing repeated administration of local anaesthetic in the postoperative period. Forty patients were randomly allocated pre-operatively into one of two groups to receive in a double-blind manner either lignocaine 1% or normal saline. ⋯ Postoperative pain scores were significantly reduced (p < 0.05) after injection of lignocaine through the catheter. There were no complications related to the technique and no evidence of local anaesthetic toxicity. Lignocaine instilled into the Pouch of Douglas is an effective method for postoperative pain relief after laparoscopic sterilisation.