Anaesthesia
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Randomized Controlled Trial Multicenter Study
Ondansetron has similar clinical efficacy against both nausea and vomiting.
Ondansetron is widely believed to prevent postoperative vomiting more effectively than nausea. We analysed data from 5161 patients undergoing general anaesthesia who were randomly stratified to receive a combination of six interventions, one of which was 4 mg ondansetron vs placebo. For the purpose of this study a 20% difference in the relative risks for the two outcomes was considered clinically relevant. ⋯ Vomiting was reduced from 17% (441/2585) to 11% (293/2576), corresponding to a relative risk of 0.67, or a relative risk reduction of 33%. The relative risks of 0.67 and 0.74 were clinically similar and the difference between them did not reach statistical significance. We thus conclude that ondansetron prevents postoperative nausea and postoperative vomiting equally well.
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Randomized Controlled Trial Comparative Study
Tramadol for prevention of postanaesthetic shivering: a randomised double-blind comparison with pethidine.
The present study was conducted with the aims of comparing intravenous tramadol 1, 2 and 3 mg.kg(-1) with pethidine 0.5 mg.kg(-1) for prophylaxis of postanaesthetic shivering and to find a dose of tramadol that could provide the dual advantage of antishivering and analgesic effect in the postoperative period. The study included 165 patients, randomly allocated to five groups of 33 each. ⋯ All three doses of tramadol were effective and comparable to pethidine in preventing postanaesthetic shivering. Tramadol 2 mg.kg(-1) had the best combination of antishivering and analgesic efficacy without excessive sedation and thus appeared to be a good choice to be administered at the time of wound closure to provide antishivering effect and analgesia without significant side effects in the postoperative period.
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Randomized Controlled Trial Comparative Study
Ease of intubation with the GlideScope or Airway Scope by novice operators in simulated easy and difficult airways--a manikin study.
The GlideScope and Airway Scope are video laryngoscopes that have been found to be useful in difficult airway situations. With the GlideScope, there are frequently problems associated with insertion of the tracheal tube despite the ability to view the glottis. The Airway Scope's imaging system and disposable PBlade aid alignment of the PBlade with the glottis and guide insertion of the tracheal tube. ⋯ We found that the students required less time for tracheal intubation with the Airway Scope and reported greater ease of intubation with the Airway Scope in both scenarios. A greater number of students chose the Airway Scope as their device of choice. Our results suggest that the Airway Scope's features may improve the ease of tracheal intubation compared with the GlideScope.
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Review
B type natriuretic peptide--a diagnostic breakthrough in peri-operative cardiac risk assessment?
The B-type natriuretic peptides; B-type natriuretic peptide and N-terminal pro-B-type natriuretic peptide, are increasing being used as biomarkers for the diagnosis, management and prognostication of cardiac failure, but their application in the peri-operative period is unclear. This review examines the current understanding of the role of B-type natriuretic peptides in both the operative and non-operative settings. ⋯ Using this as a background, the role of B-type natriuretic peptides in the prediction of peri-operative mortality and morbidity is examined and potential confounders, such as renal failure and body mass index, which may impact significantly on the utility of the biomarkers, are discussed. Clinical recommendations with regard to its use are made and a research agenda is proposed for future peri-operative studies.
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Anaesthetists are legally obliged to obtain informed consent before performing regional analgesia in labour. A postal survey of consultant-led UK anaesthetic units was performed in September 2007 to assess practice regarding obtaining informed consent before inserting an epidural, and documentation of the risks discussed. ⋯ There was great variation between units regarding which risks women were informed about and the likely incidence of that risk. One hundred and twenty-three respondents out of 157 providing an epidural service (78%) supported a national standardised information card endorsed by the Obstetric Anaesthetists' Association, with all the benefits and risks stated, to be shown to all women before consenting to an epidural in labour.