Anaesthesia
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Randomized Controlled Trial Clinical Trial
Respiratory complications associated with tracheal extubation. Timing of tracheal extubation and use of the laryngeal mask during emergence from anaesthesia.
Sixty patients were randomly allocated to one of three groups and the incidences of respiratory complications which occurred during emergence from anaesthesia were compared under the following three circumstances: tracheal extubation after the patient had regained consciousness (awake group); tracheal extubation while the patient was still anaesthetised (anaesthetised group); and the use of the laryngeal mask during emergence from anaesthesia (mask group). In the mask group, the laryngeal mask was inserted under deep anaesthesia before tracheal extubation and the lungs were ventilated through the laryngeal mask after tracheal extubation. In the awake group, straining (bucking) occurred in 18 patients and desaturation (arterial oxygen haemoglobin saturation < 95%) in two patients. ⋯ No respiratory complications occurred in two patients in the awake group, three patients in the anaesthetised group and 16 patients in the mask group. The incidence of respiratory complications during recovery from anaesthesia was significantly lower in the mask group than in the other two groups (pooled) (p < 0.001). Therefore, the use of the laryngeal mask after tracheal extubation decreases the incidence of respiratory complications during recovery from anaesthesia.
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We describe the management of a 25-year-old primigravida with severe respiratory insufficiency secondary to CHarcot-Marie-Tooth disease type I scheduled for Caesarean section. Incremental subarachnoid anaesthesia via a microcatheter was utilised. Mother and baby made an uneventful recovery and were discharged home on the tenth postoperative day.
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In a series of studies designed to investigate the need for a temperature-compensated vaporiser for use in a circle system, we first studied temperature changes within and isoflurane concentration delivered by a Komesaroff vaporiser during bench tests using different gas flows. Agent temperature and vapour concentration decreased as predicted by the Antoine equation. Using the vaporiser within a circle system during clinical anaesthesia, we then studied 20 patients breathing spontaneously and a further 10 patients receiving controlled ventilation, measuring the temperature of the agent within the vaporiser and the concentration of agent inspired by a the patient. In clincial use with the frest gas flows of 1-3.min-1, the inspired agent concentration did not decrease despite the decrease in temperature of the liquid isoflurane in the vaporiser.
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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.