Anaesthesia
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Randomized Controlled Trial Comparative Study
Study of a combined percutaneous local anaesthetic and the TDS system for venepuncture.
Transdermal Delivery System (TDS) is a liquid formulation which can be applied to the skin via a metered pump spray to deliver drug across skin. This placebo controlled, double blind trial compared anaesthetic properties of two TDS systems (TDS alpha and TDS beta) with placebo. The active and placebo treatments were applied to the dorsum of the hands, bilaterally and simultaneously for 5 min on 100 healthy volunteers. ⋯ Lidocaine plasma levels were assessed at 0 and 2 h. The VRS and VAS results show that TDS beta significantly decreased pain score compared to placebo (p < 0.02). Blood lidocaine at 2 h post application was also higher for TDS beta than for TDS alpha, suggesting that a 5 min application of TDS beta was effective in delivering local anaesthetic and accelerating the onset of skin anaesthesia prior to venous cannulation in adults.
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Anaesthetists and intensivists spend a considerable proportion of their working time inserting needles and catheters into patients. In order to access deeper structures like central veins and nerves, they have traditionally relied on surface markings to guide the needle into the correct position. However, patients may present challenges due to anatomical abnormalities and size. ⋯ As a result of limited training in the use of ultrasound we believe that many clinicians fail to use it to its full potential. A lack of understanding, with regard to imaging the location of the needle tip remains a major obstacle. Needle visualisation and related topics form the basis for this review.
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We prospectively estimated the prevalence of heart murmurs in 2522 consecutive adult non-cardiac surgery patients during pre-operative evaluation. Factors that contribute to the detection of a heart murmur were identified, and echocardiography was used to evaluate to what extent a murmur reflected presence of valvular heart disease. A cardiac murmur was detected in 106 patients (prevalence 4.2%, 95% CI: 3.5-5.1%). ⋯ Murmurs in patients younger than 40 years never reflected valvular heart disease. Pre-operative cardiac auscultation seems only reasonable in patients aged 40 years or older. Subsequent echocardiography in these selected patients is necessary.
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Letter Case Reports
Shearing of a Frova Intubating Introducer by a Bronchocath double lumen tube.
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Randomized Controlled Trial Comparative Study
Haemodynamic effects of the prone position: a comparison of propofol total intravenous and inhalation anaesthesia.
The haemodynamic changes of the prone position were investigated in 40 ASA I-II patients undergoing lumbar spine surgery. Patients were randomly assigned, following propofol intravenous induction, to receive maintenance of anaesthesia using either isoflurane 1-1.2% in air or target controlled propofol 3 microg.ml(-1) infusion. Measurements of non-invasive blood pressure, heart rate and cardiac output were made in the supine position. ⋯ Cardiac output measurements were made using a non-invasive cardiac output monitor. We found a significant reduction in cardiac index in both groups and a significantly greater change with propofol compared to isoflurane on turning supine to prone (CI change 0.4 vs 0.7 l.min(-1).m(-2) p = 0.001 and SVRI change 89 vs 177 dyne.s(-1).cm(-5), p = 0.041). We conclude that turning healthy patients prone produces a clinically significant reduction in cardiac output, the change being greater during maintenance of anaesthesia using propofol compared to isoflurane.