Anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of two airway aids for emergency use by unskilled personnel. The Combitube and laryngeal mask.
Many non-anaesthetists find airway control and intubation difficult. The laryngeal mask has been advocated for use by non-anaesthetists at cardiorespiratory arrests, whilst the Combitube is said to provide protection from aspiration. We wished to determine which device was easiest for unskilled staff to use. ⋯ Both devices were successfully placed in 24/26 patients. The median times to insertion were 40 s and 45 s for the laryngeal mask and Combitube, respectively, with two failures, both with the Combitube (p > 0.05); these were due to faulty operator technique. The Combitube may be a suitable alternative to the laryngeal mask for use in resuscitation by unskilled staff.
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Clonidine has proved to be a clinically useful adjunct in clinical anaesthetic practice as well as in chronic pain therapy because it has both anaesthetic and analgesic-sparing activity. The more selective alpha-2 adrenoceptor agonists, dexmedetomidine and mivazerol, may also have a role in providing haemodynamic stability in patients who are at risk of peri-operative ischaemia. The side-effects of hypotension and bradycardia have limited the routine use of alpha-2 adrenoceptor agonists. ⋯ We discuss the pharmacology of alpha-2 adrenoceptors and their therapeutic role in this review. The alpha-2 adrenoceptor agonists are agonists at imidazoline receptors which are involved in central blood pressure control. Selective imidazoline agonists are now available for clinical use as antihypertensive agents and their pharmacology is discussed.
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Case Reports
Radicular acute pain after epidural anaesthesia with the technique of loss of resistance with normal saline solution.
Epidural anaesthesia using the loss of resistance to saline technique, without air, was successfully performed in a 65-year-old man scheduled for elective vascular surgery of the right leg. Epidural catheterisation was uneventful. ⋯ After excluding other causes, the spontaneous entry of air through the Tuohy needle was thought to be the most likely explanation for this complication. The patient recovered uneventfully.
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Fatal oesophageal perforation occurred as a complication of elective general anaesthesia for cataract extraction in a 77-year-old female patient. Tracheal intubation had been achieved, albeit with difficulty, in the course of a clinical trial of the intubating laryngeal mask.
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It has been shown that instructions to authors in nonanaesthesia biomedical journals often fail to require authors to state that the study was approved by an ethics committee and informed consent obtained from participants; articles also often omit mentioning these points. We examined 11 English-language journals, which are listed in the 'Anesthesiology' category of 1995 SCI Journal Citation Reports, to see whether the instructions to authors of anaesthesia journals mention the following ethical factors: approval of the study by an ethics committee, informed consent, redundant publication, fraud, authorship, conflict of interest and protection of patients' privacy. We also examined 673 articles which appeared in these anaesthesia journals ( July to December issues of 1996) to see whether they stated acquirement of ethics committee approval and informed consent. ⋯ Ten journals required approval of studies and signatures from all authors, eight journals mentioned informed consent. Only seven required the disclosure of any conflict of interest and the protection of patients' privacy. More than 90% of the articles stated that the study was approved and informed consent obtained.