British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Hypoxaemia is reduced by pulse oximetry monitoring in the operating theatre and in the recovery room.
To determine the impact of pulse oximeter monitoring on the incidence, severity and duration of hypoxaemia in the operating theatre (OT) and in the recovery room (RR), we investigated 200 patients in a randomized study. The extent of hypoxaemia in the OT was compared with that in the RR. Adult inpatients were allocated randomly to two groups: group I, pulse oximeter data and alarms "available"; group II, these data "unavailable" to the anaesthesia team and RR staff. ⋯ The incidence and severity of hypoxaemia in the OT and in the RR were comparable, whereas the cumulative duration of hypoxaemia was significantly greater in the RR than in the OT. The occurrence of hypoxaemia in an individual patient in the OT significantly increased this patient's risk of suffering hypoxaemia in the RR. We conclude that the extent of hypoxaemia, especially in the RR, may be reduced significantly by pulse oximeter monitoring, but even with the information provided, some patients still develop hypoxaemia.
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Clonic and tonic seizure-like movements of the extremities were observed during induction of anaesthesia with sevoflurane in a 9-yr-old girl. The tonic movements were associated with respiratory alkalosis and were not abolished by an i.v. injection of thiamylal 75 mg. ⋯ No neurological abnormalities were obvious after the anaesthesia. The movements may have been the result of seizure activity in the central nervous system, or myoclonus of the extremities.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of the train-of-four fade profiles produced by vecuronium and atracurium.
In this double-blind study, we have allocated randomly 40 ASA I-III patients to one of four groups. After a standard anaesthetic induction, patients received vecuronium 0.08 mg kg-1 or 0.10 mg kg-1, or atracurium 0.4 mg kg-1 or 0.5 mg kg-1. ⋯ During recovery of neuromuscular transmission, vecuronium was associated with more fade than atracurium. The differences in the TOF profiles of these two drugs may be important when judging the adequacy of antagonism of neuromuscular block using the TOF response.
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Randomized Controlled Trial Comparative Study Clinical Trial
Topical anaesthesia of the nasal mucosa for fibreoptic airway endoscopy.
We have compared four methods of topical anaesthesia of the nostril for fibreoptic airway endoscopy in a randomized study with 31 unpremedicated volunteers, each serving as his or her own control. Lignocaine spray, EMLA cream, three cotton swabs soaked in 4% lignocaine solution, or 2% lignocaine gel was applied in a nostril for 3 min. Application of lignocaine spray was rated as the most unpleasant and EMLA cream the least unpleasant. ⋯ Gel or EMLA, but not the local anaesthetic applied with swabs, obscured vision. When slight obscurity of vision is not a problem, local anaesthetic gel is recommended for anaesthesia of the nasal mucosa. Premedication or sedation is recommended for all the methods described here.
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A completed questionnaire was returned by 246 (85%) intensive care units participating in a national survey of infection control practice in intensive care. Thirty-three units had no provision for isolating patients in single side wards. Sixty percent of responding ICU had fewer than one washbasin per bedspace. ⋯ K. were using a selective decontamination regimen, and nine of these (50%) had no full time consultant microbiologist available to supervise the recommended microbiological management. The majority of ICU received a regular visit (greater than or equal to one per week) from a microbiologist. Proposals are made on the development of a specialized infection control service in order to reduce the risk of nosocomial infection in intensive care, and to improve on existing resource management.