Anaesthesia
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Randomized Controlled Trial Comparative Study
The analgesic effects of intrathecal morphine in comparison with ultrasound-guided transversus abdominis plane block after caesarean section: a randomised controlled trial at a Ugandan regional referral hospital.
What did they do?
The researchers randomised 130 women to 10 mg intrathecal hyperbaric bupivacaine plus an ultrasound-guided TAP block, or to 10mg intrathecal hyperbaric bupivacaine with 100 mcg morphine, plus a sham TAP block.
And they found
There was no difference between either group for satisfaction, analgesia or adverse effects. They concluded that in the context of intrathecal morphine availability, there is no benefit from TAP block, although TAP block can produce comparable analgesia if IT morphine is not used.
What’s particularly interesting...
Unlike the majority of obstetric anaesthesia research, this study comes from the same environment that also manages the bulk of global deliveries: low and medium income countries.
It is also an important reminder that not only are techniques used in wealthier countries applicable and translatable to lower-resource settings, but so is high quality research – and as with all research, context is everything.
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Randomized Controlled Trial Comparative Study
Fibreoptic-guided tracheal intubation through i-gel® and LMA® ProtectorTM supraglottic airway devices - a randomised comparison.
Fibreoptic-guided tracheal intubation using a supraglottic airway device as a conduit is a technique that can be used in anticipated and unanticipated difficult airway management. Although the i-gel® supraglottic airway device has been examined for this purpose, the LMA® ProtectorTM , a recently introduced second-generation supraglottic airway device, has not been evaluated for this use in clinical trials. This prospective, randomised clinical trial compared fibreoptic-guided tracheal intubation via i-gel and LMA Protector supraglottic airway devices in two UK hospitals. ⋯ Mean (SD) tracheal intubation time in the i-gel and LMA Protector groups were 54.3 (13.8) s and 52.0 (13.0) s, respectively (p = 0.240). There were no significant differences in tracheal intubation success rate, glottic view and ease of tracheal intubation between the two groups. This study demonstrates that the LMA Protector supraglottic airway device is comparable to the i-gel supraglottic airway device as a conduit for fibreoptic-guided tracheal intubation.
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Guidelines are presented for safe practice in the use of intravenous drug infusions for general anaesthesia. When maintenance of general anaesthesia is by intravenous infusion, this is referred to as total intravenous anaesthesia. Although total intravenous anaesthesia has advantages for some patients, the commonest technique used for maintenance of anaesthesia in the UK and Ireland remains the administration of an inhaled volatile anaesthetic. ⋯ Therefore, all anaesthetists should be able to deliver total intravenous anaesthesia competently and safely. For the purposes of simplicity, these guidelines will use the term total intravenous anaesthesia but also encompass techniques involving a combination of intravenous infusion and inhalational anaesthesia. This document is intended as a guideline for safe practice when total intravenous anaesthesia is being used, and not as a review of the pros and cons of total intravenous anaesthesia vs. inhalational anaesthesia in situations where both techniques are possible.