Anaesthesia
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Comparative Study
Emergency cricothyrotomy: a randomised crossover trial comparing the wire-guided and catheter-over-needle techniques.
In a randomised crossover trial, we compared a wire-guided cricothyrotomy technique (Minitrach) with a catheter-over-needle technique (Quicktrach). Performance time, ease of method, accuracy in placement and complication rate were compared. Ten anaesthesiology and 10 ENT residents performed cricothyrotomies with both techniques on prepared pig larynxes. ⋯ There was one complication in the catheter-over-needle group compared to five in the wire-guided group. We conclude that the wire-guided minitracheotomy kit is unsuitable for emergency cricothyrotomies performed by inexperienced practitioners. On the other hand, the catheter-over-needle technique appears to be quick, safe and reliable.
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The addition of epinephrine to solutions containing fentanyl and bupivacaine for epidural infusion has been shown to improve the quality of analgesia. However, this admixture is not available commercially in the United Kingdom. ⋯ All infusions were found to be stable over the study period (> 90% remaining) using stability-indicating High Performance Liquid Chromatography (HPLC) methods, with no changes in physical appearance or pH (range 4.5-4.2). The infusions were prepared using standard pharmaceutical products, so facilitating the batch preparation of epinephrine, fentanyl and bupivacaine epidural solutions by hospital pharmacy departments.
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Randomized Controlled Trial Comparative Study Clinical Trial
Extending low-dose epidural analgesia for emergency Caesarean section using ropivacaine 0.75%.
We compared ropivacaine 0.75% and bupivacaine 0.5% for extending low-dose epidural analgesia for emergency Caesarean section, using a prospective double-blind randomised controlled trial design. The trial was halted after 45 patients were studied (23 ropivacaine; 22 bupivacaine) because bupivacaine was replaced by levobupivacaine in our unit. Time to reach T4 for loss of cold sensation was similar in both groups, although analgesic supplementation was required less often in the ropivacaine group than in the bupivacaine group (2/23 vs. 9/21; p = 0.01).
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Randomized Controlled Trial Comparative Study Clinical Trial
Left ventricular mechanical performance in elderly patients after induction of anaesthesia. A comparison of inhalational induction with sevoflurane and intravenous induction with fentanyl and propofol.
We investigated changes in left ventricular mechanical performance in 40 patients aged > 70 years in whom anaesthesia had been induced with sevoflurane or with fentanyl and propofol. The ratio of ventricular contractility to arterial properties, which reflects left ventricular performance, was estimated from the ratio of ventricular end-systolic elastance to effective arterial elastance. ⋯ Decreases in mean arterial pressure after induction of anaesthesia in the two groups were similar, whereas the magnitude of the decrease in heart rate in the sevoflurane group was greater than that in the fentanyl/propofol group. Sevoflurane may therefore be preferable to fentanyl and propofol for induction of anaesthesia in elderly patients because of its lesser effect on left ventricular performance.