Anaesthesia
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Randomized Controlled Trial Clinical Trial
Low-dose bupivacaine-fentanyl spinal anaesthesia for transurethral prostatectomy.
We evaluated the effect of low-dose bupivacaine plus fentanyl administered intrathecally in elderly patients undergoing transurethral prostatectomy. Patients were randomly assigned to one of two groups. Group F received plain bupivacaine 4 mg with 25 micro g of fentanyl and sterile water to a total of 1.5 ml, and Group B received only 0.5% plain bupivacaine 7.5 mg for spinal anaesthesia. ⋯ The mean level of motor block was higher and the duration of motor block was longer in Group B (p < 0.0001). Hypotension and shivering were significantly more common in Group B (p < 0.05). The addition of fentanyl 25 micro g to plain bupivacaine 4 mg provides adequate analgesia for transurethral prostatectomy with fewer side-effects in elderly patients when compared with the conventional dose of bupivacaine.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of the effect of two anaesthetic techniques on surgical conditions during gynaecological laparoscopy.
In a prospective, randomised, controlled trial, we compared the effects of two anaesthetic techniques on surgical conditions during day-case, gynaecological laparoscopic procedures in 40 female patients. Patients were allocated randomly to two groups, either to breathe spontaneously through a laryngeal mask airway or to receive a neuromuscular-blocking agent (NMB) and have the lungs ventilated via a tracheal tube. We then measured the number of attempts of Verres' needle insertion, initial intra-abdominal pressure, time to reach a steady 15 mmHg (1.97 kPa) of intra-abdominal pressure, adequacy of the pneumoperitoneum, operative view and duration of operation. ⋯ The adequacy of the pneumoperitoneum for trocar placement was better in the NMB group. We conclude that the anaesthetic technique of spontaneously breathing through a laryngeal mask airway reduces total operation time. However surgeons should be aware of the different abdominal pressure patterns produced by each anaesthetic technique, and anaesthetists must consider the implications of the anaesthetic technique on surgical safety.
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Sexual hallucinations have been reported since the introduction of chloroform. Newer agents such as midazolam and propofol appear particularly prone to producing them. ⋯ Other individuals, including doctors, have used the amnesic effects of midazolam and other drugs to sexually assault victims. Clinicians should be aware of the risks to which they may inadvertently expose themselves if these drugs are not used carefully.
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Major shoulder surgery can be extremely painful. Interscalene brachial plexus catheters provide excellent postoperative analgesia but are technically difficult to place. A new insulated Tuohy needle system for plexus catheterisation is now available. ⋯ Mean [range] catheter insertion time was 3.6 [1-10] min. Decreased block and catheter insertion times were associated with experience with the equipment when comparing the mean (SD) times for the first seven catheters and the last seven catheters inserted (12.1 (4.2) min vs. 7.9 (2.4) min), p < 0.05). It is concluded that the insulated Tuohy needle system for interscalene catheterisation proved easy to use in the hands of someone who had not used it before, and can be recommended.
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Fatigue has been implicated in the occurrence of critical incidents. Using a driving simulator to assess vigilance, we investigated the effect of sleep disruption on the ability of anaesthetists to maintain vigilance after a night on-call. Following an undisturbed night of sleep, subjects demonstrated a significant improvement in their vigilance scores. ⋯ The timing of disturbance had a bearing on performance. Subjects' performance was worse if their sleep had been disturbed in the first third of the night. The effect of sleep disruption on vigilance has implications for patient safety during anaesthesia.