Anaesthesia
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Letter Clinical Trial Controlled Clinical Trial
Intranasal fentanyl for postoperative analgesia after elective Caesarean section.
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Randomized Controlled Trial Multicenter Study Clinical Trial
To shape or not to shape...simulated bougie-assisted difficult intubation in a manikin.
Thirty anaesthetists attempted to place a derived 'optimal' curve bougie or a straight bougie in the trachea of a manikin, in a randomised cross-over study. A Grade 3 Cormack and Lehane laryngoscopic view was simulated. The anaesthetists were blinded to success (tracheal placement) or failure (oesophageal placement). ⋯ On a separate occasion, under identical laboratory conditions, 30 anaesthetists attempted to place a straight coudé (angled)-tipped bougie or a straight straight-tipped bougie in the trachea of a manikin. The success rates with the coudé- and straight-tipped bougies were 43 and 0%, respectively, giving a difference (95% confidence interval) of 43% (21-61%) between the two bougies (p < 0.001). These results suggest that bougies used to facilitate difficult intubation should be curved and have a coudé tip.
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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.
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The purpose of this investigation was the description of structure and process quality based on the analysis of 1612 fibreoptic intubations. We evaluated all fibreoptic intubations (nasotracheal in awake patients and orotracheal in anaesthetised patients) from a previously described database over a period of 2 years. We assessed structure quality by evaluating the distribution of the fibreoptic intubations across all staff anaesthetists, and process quality by analysing the number of attempts, the time required, the cases where we had to switch to conventional intubation and the complications. ⋯ Within 3 min, 93.9% of all fibreoptic intubations were successfully completed. In 24 cases, fibreoptic intubation was abandoned. Severe nasal bleeding as a major complication occurred in 1.3% of the nasotracheal intubations.