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 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 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.