British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Assessment of intubating conditions in children after induction with propofol and varying doses of alfentanil.
We have assessed tracheal intubating conditions in 60 ASA I or II children, aged 3-12 yr, after induction of anaesthesia with alfentanil 5, 10 or 15 micrograms kg-1, followed by an induction dose of propofol. Neuromuscular blocking agents were not given. ⋯ Intubation was successful in 70%, 95% and 95% of patients after alfentanil 5, 10 or 15 micrograms kg-1, respectively, and conditions were considered to be excellent in 20%, 70% and 80% of patients, respectively. Side effects included pain on injection of propofol (27%), excitatory movements (5%) and bradycardia (1.7%).
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of the effects of sevoflurane and halothane on the quality of anaesthesia and serum glutathione transferase alpha and fluoride in paediatric patients.
We have compared sevoflurane and halothane anaesthesia in paediatric patients with reference to induction and recovery. We also assessed hepatocellular integrity by measurement of serum glutathione transferase alpha (GSTA) concentration and sevoflurane metabolism by serum fluoride concentration. Fifty unpremedicated 5-12-yr-old children were allocated randomly to induction of anaesthesia via a face mask with 66% nitrous oxide in oxygen and sevoflurane (up to 7%) or halothane (up to 3.5%). ⋯ Serum concentrations of fluoride were significantly greater after sevoflurane than after halothane anaesthesia. There were no clinical signs or symptoms of hepatic or renal disturbance. Children tolerated sevoflurane better than halothane, which may have been because of the nonpungency of sevoflurane and the rapid psychomotor recovery after anaesthesia.
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Randomized Controlled Trial Clinical Trial
Extradural analgesia in labour: complications of three techniques of administration.
We have studied the complications associated with three techniques used to maintain extradural analgesia in labour: midwife top-up doses of 0.25% bupivacaine 10 ml, continuous infusion of 0.125% bupivacaine 10 ml h-1 and patient-controlled extradural analgesia (PCEA) with self-administered 3-ml bolus doses of 0.25% bupivacaine. A significantly higher intervention rate by an anaesthetist was required in the continuous infusion group. ⋯ Uneventful hypotension occurred in three women; two receiving PCEA and one receiving continuous infusion. Ten women experienced sensory blocks extending above T7 with no ill effects; seven receiving PCEA and three continuous infusion.
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Comparative Study
Tracheal intubation in a manikin: comparison of supine and left lateral positions.
Tracheal intubation in the left lateral position may be necessary in some circumstances. Using a manikin we demonstrated that anaesthetic trainees found tracheal intubation in the left lateral position was more difficult and took longer than in the supine position. However, the time to successful tracheal intubation decreased with practice, indicating the presence of a learning curve. We suggest that tracheal intubation in the left lateral position should become part of training in the management of the difficult airway.
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Randomized Controlled Trial Clinical Trial
Continuous monitoring of depth of sedation by EEG spectral analysis in patients requiring mechanical ventilation.
Twenty-three patients undergoing intensive therapy had continuous EEG recording in an attempt to assess depth of sedation using spectral analysis. Median power frequency (MPF) and spectral edge frequency (SEF) were calculated and correlated with the clinical sedation score and blood concentration of sedative drug. ⋯ There was no correlation between MPF or SEF and sedation score or blood concentration of drug. These results suggest that no simple measure of the EEG is likely to correlate with depth of sedation in critically ill patients.