Anaesthesia
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Letter Clinical Trial Controlled Clinical Trial
Intranasal fentanyl for postoperative analgesia after elective Caesarean section.
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The effects of introducing Modified Early Warning scores to identify medical patients at risk of catastrophic deterioration have not been examined. We prospectively studied 1695 acute medical admissions. All patients were scored in the admissions unit. ⋯ The therapeutic interventions performed in response to abnormal scores were not assessed. We are convinced that the Modified Early Warning score is a suitable scoring tool to identify patients at risk. However, outcomes in medical emergency admissions are influenced by a multitude of factors and so it may be difficult to demonstrate the score's benefit without further standardizing the response to abnormal values.
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A timesheet questionnaire was used to assess the time it took from informing the anaesthetist about a case to the start of operative delivery in 78 consecutive patients undergoing caesarean section. Median (IQR [range]) times for grade-1 cases (immediate threat to the life of the mother or fetus) and grade-2 cases (fetal or maternal compromise without immediate threat to life) were 20 (17-35 [6-75]) min and 41 (27-60 [17-136]) min, respectively. ⋯ Many significant delays were apparently not perceived by the anaesthetist. In nine (69%) grade-1 cases, the 30-min target decreed by the Association of Anaesthetists of Great Britain & Ireland and the Obstetric Anaesthetists' Association was achieved.
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Randomized Controlled Trial Clinical Trial
A new formulation of nasal fentanyl spray for postoperative analgesia: a pilot study.
Twenty-four gynaecological patients receiving postoperative patient-controlled analgesia were enrolled in an open cross-over pilot study evaluating two new formulations of nasal fentanyl spray. The primary outcome was the bioavailability of nasal fentanyl in comparison with intravenous fentanyl. This manuscript describes the clinical outcomes of quality of postoperative analgesia and patient acceptability. ⋯ There was no significant difference in side-effects. Four patients experienced mild nasal stinging and although 10 (42%) preferred intravenous administration, seven (29%) preferred intranasal and six (25%) had no preference. We conclude that these formulations of fentanyl, delivered as nasal spray, have potential clinical utility.
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Randomized Controlled Trial Clinical Trial
A 5-microm filter does not reduce propofol-induced pain.
We assessed the effectiveness of a 5-microm filter in reducing propofol-induced pain and determined whether any reduction is due to removal of contaminants or an alteration in flow characteristics. A total of 120 unpremedicated women (ASA 1-3, aged 18-70 yr) were randomly allocated to one of three equal-sized groups. In group A, propofol was drawn up and injected through an unfiltered plastic cannula. ⋯ The pain score for the patient was the taken as the most severe pain documented. The frequency and severity of pain were similar among groups. We conclude that a 5-microm filter does not reduce pain associated with injection of propofol drawn from a vial with a rubber bung.