British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Learning fibreoptic intubation: use of simulators v. traditional teaching.
This study compared a graduated training programme with that of a traditional teaching method to facilitate the learning of the technique of fibreoptic nasotracheal intubation. Thirty-two anaesthesia trainees were randomly assigned to two groups. ⋯ Nasotracheal intubation was accomplished significantly more often by the trainees in the graduated programme (86 out of 96 (89.6%) v. 64 out of 96 (66.5%) (P less than 0.01). The results demonstrate that trainees who undergo a graduated training programme using simulators are initially more successful at awake fibreoptic nasotracheal intubation than those who have learned in the traditional manner, and that the conditions of the investigation were acceptable to the trainees and patients.
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Comparative Study
Haemodynamic and heart rate reflex responses to propofol in the rabbit. Comparison with althesin.
Propofol was administered to eight rabbits by constant i.v. infusion at 0.2, 0.4 and 0.6 mg kg-1 min-1 to produce light sedation. The lowest dose was compared with an infusion of Althesin 0.1 mg kg-1 min-1. The rabbits had been previously implanted with aortic and vena caval perivascular balloon cuffs to examine the baroreceptor-heart rate reflex and an aortic thermistor catheter for cardiac output (CO) measurements. ⋯ A dose-related reduction in the range and gain of the baroreceptor-heart rate reflex was observed with propofol (P less than 0.05). The pattern of alteration of the reflex curve, however, differed between the two anaesthetics and the vagal efferent component was more resistant to blockade with propofol. The relative preservation of baroreceptor reflex responses, and the reduction in TPR by a reduction of resting constrictor tone, suggest propofol may have significant clinical advantages when used as a sedative infusion.
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The amount of larynx seen at intubation was assessed in 633 adult patients undergoing routine surgery. Various measurements of the head and neck were made in an attempt to discover which features were associated with difficulty with laryngoscopy (defined as the inability to see even the arytenoids). ⋯ A simple predictive rule was developed and tested on a prospective set of 778 patients, in 1.5% of whom laryngoscopy was found to be difficult. Depending on the threshold chosen, the rule allowed the detection of, for example, 75% of the "difficult" laryngoscopies at a cost of falsely identifying 12% of the "not difficult" patients.
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Randomized Controlled Trial Comparative Study Clinical Trial
Intercostal nerve blockade producing analgesia after appendicectomy.
Intercostal nerve blockade of the 10th, 11th and 12th thoracic nerves on the right side was compared with i.m. papaveretum as analgesia after appendicectomy. Patients with intercostal nerve blockade had significantly less pain at 0, 4, 8 and 12 h after operation and required less papaveretum (mean 0.26 mg kg-1/24 h) compared with the controls (mean 0.62 mg kg-1/24 h). There were no complications in either group. Intercostal nerve blockade may provide better quality analgesia following appendicectomy than i.m. papaveretum alone.