Anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of sevoflurane-nitrous oxide anaesthesia with the conventional intravenous-inhalational technique using bispectral index monitoring.
Ninety-one patients were randomly allocated to one of two groups. Group A was induced with a single vital capacity breath of 6% (end-tidal) sevoflurane in nitrous oxide-oxygen (2 : 1 l.min-1), whereas group B was induced with intravenous fentanyl 1 microg.kg-1 + propofol 2 mg.kg-1 followed by nitrous oxide-oxygen (2 : 1 l.min-1) and sevoflurane. Induction was considered to have been achieved when the bispectral index value decreased to below 70. ⋯ Mild coughing was more common in group A, but relative hypotension was more common in group B. There was no difference in the emergence times. Thirty minutes after emergence, there was no difference in the incidence of adverse effects, with the exception of essentially mild abdominal pain which was more frequent in group A.
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Randomized Controlled Trial Clinical Trial
Evaluation of the disposable Vital View laryngoscope apparatus.
The Vital View laryngoscope (Vital Signs, NJ, USA) consists of a plastic disposable blade containing a fibrelight and a non-disposable handle; there is therefore no need to sterilise the blade and no concern about disintegration of the fibrelight. In a random cross-over design, we compared the Vital View laryngoscope with a conventional metal fibrelight laryngoscope (Welch Allyn, NY, USA) in 100 patients. The Vital View laryngoscope produced a brighter field than the metal laryngoscope (p < 0.001), whereas there was no significant difference in the view of the glottis or the success rate of tracheal intubation. ⋯ In another 10 patients, prevention of light emission from the side of the laryngoscope blade reduced the brightness (p < 0. 01). This indicated that the brightness of the Vital View laryngoscope is produced by light emission not only from the tip of the blade but also from the side of the blade. Therefore, the disposable Vital View laryngoscope can be used as effectively as a conventional non-disposable laryngoscope.
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Randomized Controlled Trial Clinical Trial
Postoperative residual block after intermediate-acting neuromuscular blocking drugs.
The frequency and duration of postoperative residual neuromuscular block on arrival of 150 patients in the recovery ward following the use of vecuronium (n = 50), atracurium (n = 50) and rocuronium (n = 50) were recorded. Residual block was defined as a train-of-four ratio of <0.8. An additional group of 10 patients received no neuromuscular blocking drugs during anaesthesia. ⋯ None of the 10 patients who did not receive neuromuscular blocking drugs had train-of-four ratios <0.8 on arrival in the recovery ward. It is concluded that a large proportion of patients arrive in the recovery ward with a train-of-four ratio <0.8, even with the use of intermediate-acting neuromuscular blocking drugs. Although the residual block is relatively short lasting, it may occasionally be prolonged, requiring close observation and monitoring of such patients in the recovery ward.
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The high price of xenon has prevented its use in routine, clinic anaesthetic practice. Xenon therefore has to be delivered by closed-circuit anaesthesia. The accumulation of nitrogen is a significant problem within the closed circuit and necessitates flushing, which in turn increases gas expenditure and costs. ⋯ Anaesthesia time was 2 h. Nitrogen concentrations in the closed system ranged from 0.08 to 7.04% and were not significantly different from those observed during low-flow anaesthesia. Closed-circuit anaesthesia reduced the xenon expenditure 10-fold compared with low-flow anaesthesia.