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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Case Reports Randomized Controlled Trial
Incidence of clinically symptomatic pneumothorax in ultrasound-guided infraclavicular and supraclavicular brachial plexus block.
The use of periclavicular brachial plexus block as regional anaesthesia for surgical procedures on the upper extremity is common. However, the proximity of the pleura results in a risk of pneumothorax. Without ultrasound monitoring, the pneumothorax risk has been reported to be as high as 6.1%. ⋯ Ultrasound guidance does therefore appear to reduce the risk of pneumothorax. Although all of the anaesthesiologists involved in the complications had previously performed fewer than 20 blocks, we are not able to confirm that a block experience ≤ 20 is a significant risk factor. Faulty image-setting, inability to obtain a view of the needle tip and inadequate supervision are likely to be important risk factors.
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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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Drawing samples from an indwelling arterial line is the method of choice for frequent blood analysis in adult critical care areas. Sodium chloride 0.9% is the recommended flush solution for maintaining the patency of arterial catheters, but it is easy to confuse with glucose-containing bags on rapid visual examination. The unintentional use of a glucose-containing solution has resulted in artefactually high glucose concentrations in blood samples drawn from the arterial line, leading to insulin administration causing hypoglycaemia and fatal neuroglycopenic brain injury. ⋯ We also make recommendations about storage, arterial pressure monitoring and sampling systems and techniques. Finally, we make recommendations about glucose monitoring and insulin administration. It is intended that adherence to these guidelines will reduce the frequency of sample contamination errors in arterial line use and capture events, when they do occur, before they cause patient harm.