Anaesthesia
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Randomized Controlled Trial
Prophylactic vs therapeutic blood patch for obstetric patients with accidental dural puncture - a randomised controlled trial.
Epidural blood patch is a standard treatment for obstetric patients experiencing a severe post-dural puncture headache. Patients who sustained an accidental dural puncture during establishment of epidural analgesia during labour or at caesarean delivery were randomly assigned to receive a prophylactic epidural blood patch or conservative treatment with a therapeutic epidural blood patch if required. ⋯ The number of patients who needed a second blood patch did not differ significantly between the two groups: 6 (10.0%) for prophylactic epidural blood patch and 4 (11.1%) for therapeutic epidural blood patch. We conclude that prophylactic epidural blood patch is an effective method to reduce the development of post-dural puncture headache in obstetric patients.
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Randomized Controlled Trial Comparative Study
Comparison of analgesic efficacy of four-quadrant transversus abdominis plane (TAP) block and continuous posterior TAP analgesia with epidural analgesia in patients undergoing laparoscopic colorectal surgery: an open-label, randomised, non-inferiority trial.
Four-quadrant transversus abdominis plane block with bilateral posterior TAP catheters for 48 hours provides analgesia equivalent to epidural analgesia in patients having laparoscopic colorectal surgery.
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Randomized Controlled Trial Comparative Study
A randomised comparison of the i-gel™ and the Laryngeal Mask Airway Classic™ in infants.
We performed a randomised comparison of the i-gel™ and the Laryngeal Mask Airway (LMA) Classic™ in children aged less than a year who were undergoing general anaesthesia for elective surgery. Fifty-four infants were randomly allocated to either the i-gel or the LMA Classic. We measured performance characteristics, fibreoptic views through the device and complications. ⋯ Insertion of the device was considered easy in 26/27 (96%) patients in the i-gel group compared with 18/26 (69%) patients in the LMA Classic group (p = 0.009). There were no differences between the groups in insertion times, fibreoptic views through the device, airway leak pressures or complications. We conclude that the i-gel was considered easier to insert than the LMA Classic in infants.
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We measured the pulsatility indices in the inferior collateral and posterior recurrent ulnar arteries, which supply the ulnar nerve at the elbow, in 38 conscious adults. Compared with a straight 30° abducted arm, elbow flexion to 120° reduced the mean (SD) pulsatility index in the inferior artery and increased the pulsatility index in the posterior artery: from 3.36 (0.86) to 3.04 (0.94), p = 0.001, and from 3.14 (0.81) to 3.64 (1.05), p < 0.0005, respectively. The mean (95% CI) pulsatility index in the inferior artery was unaffected by shoulder abduction to 120°, but it was decreased in the posterior artery in men, from 3.06 (2.76-3.36) to 2.64 (2.34-2.95), but not women, from 3.22 (2.94-3.50) to 3.25 (2.97-3.53), p = 0.01 for men vs women. Researchers should measure arterial pulsatility indices under general anaesthesia and associate them with measures of nerve function.