Anaesthesia
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Randomized Controlled Trial Comparative Study
A comparison of the pelvic angle applied using lateral table tilt or a pelvic wedge at elective caesarean section.
Lateral table tilt or a pelvic wedge are commonly used to reduce inferior vena cava compression during obstetric anaesthesia in the supine position. Direct measurement of pelvic angle allows individual assessment of the effectiveness of these manoeuvres in achieving a tilted position. We observed routine practice during caesarean section after random allocation to one or other of these methods. ⋯ There was a significant difference between table angle and pelvic angle in the women with table tilt (p = 0.0003), but no significant difference in pelvic angle between the table tilt and wedge groups. Measurement of table angle does not represent pelvic position adequately in the majority of women. However, this study showed that lateral table tilt and a pelvic wedge were equally effective in producing tilt of the pelvis.
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Review Case Reports
Case report and literature review of chronic neuropathic pain associated with peripheral venous cannulation.
We report a case of neuropathic pain following peripheral venous cannulation for an elective surgical procedure and discuss the various mechanisms by which this could occur. The mostly likely trigger in this case is phlebitis as the onset of symptoms coincided with the local infection. Neuropathic pain can occur following innocent interventions and its impact on the patient's quality of life may be reduced by timely recognition and management.
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Randomized Controlled Trial Comparative Study
A randomised crossover trial comparing a single-use polyvinyl chloride laryngeal mask airway with a single-use silicone laryngeal mask airway.
We compared insertion rates of single-use polyvinyl chloride laryngeal mask airways (LMAs) vs single-use silicone LMAs in 72 anaesthetised patients. Both airways were produced by Flexicare Medical. Laryngeal mask airway insertion was successful on the first attempt in 68/72 (94%) polyvinyl chloride LMAs vs 64/72 (89%) silicone LMAs (p = 0.39). ⋯ Laryngeal mask airway position, as assessed using a fibrescope, was not different (p = 0.077). The median (IQR [range]) leak pressure was 16 (12-20 [6-30]) cmH(2) O for the polyvinyl LMA and 18 (13-22 [6-30]) cmH(2) O or the silicone LMA (p = 0.037). In conclusion, we did not find any important differences between polyvinyl chloride and silicone laryngeal mask airways.
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Our aim was to compare peri-operative core temperatures and the incidence of hypothermia in obese and non-obese women with active forced-air warming. Twenty female patients scheduled for abdominal surgery were allocated to two groups according to body mass index. Ten obese (30.0-34.9 kg.m(-2) ) and 10 non-obese (18.5-24.9 kg.m(-2) ) women received forced-air warming on their lower limbs. ⋯ The incidences of intra-operative hypothermia were lower in the obese group (10%) compared with non-obese group (60%; p = 0.019). In the postoperative recovery phase, the mean (SD) core temperature data were higher in the obese group than in the non-obese group (36.2 (0.4) vs 35.6 (0.5) °C, respectively (p < 0.001)). In conclusion, obese female patients have higher peri-operative core temperature and a lower incidence of hypothermia compared with non-obese female patients during abdominal surgery with active forced-air warming.
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Blood pressure measurement is an essential physiological measurement for all critically ill patients. Previous work has shown that non-invasive blood pressure is not an accurate reflection of invasive blood pressure measurement. In a transport environment, the effects of motion and vibration may make non-invasive blood pressure less accurate. ⋯ Thus, our data show that non-invasive blood pressure is not a precise reflection of invasive intra-arterial blood pressure. Mean blood pressure measured non-invasively may be a better marker of invasive blood pressure than systolic blood pressure. Our data show no evidence of non-invasive blood pressures being less accurate in an aeromedical transport environment.