British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Comparison of continuous spinal anaesthesia using a 32-gauge catheter with anaesthesia using a single-dose 24-gauge atraumatic needle in young patients.
One hundred and twenty-eight ASA I-III patients less than 40 yr of age, undergoing orthopaedic or trauma lower limb surgery, were allocated randomly to receive either continuous spinal anaesthesia (CSA) using a 32-gauge polyimide microcatheter with a permanent stylet (Rusch/TFX Medical, Duluth, GA, USA) or single-dose spinal anaesthesia (SDSA) with a 24-gauge x 103-mm Sprotte spinal needle (Pajunk, Germany). Plain bupivacaine (0.5%) was used as the local anaesthetic. The initial doses were 1 ml (5 mg) of CSA and 3 ml (15 mg) of SDSA, while the re-injection doses were 1 ml (5 mg) in the CSA group. ⋯ The segmental level of analgesia was significantly lower in the CSA group (median T10 (range T12-T8)) than in the SDSA group (T9 (T11-T5)) (P < 0.05). There were no significant differences in the incidence of postoperative complications, with two mild spinal headaches in both groups. We conclude that CSA using a microcatheter in young patients is difficult to perform and affords no advantages over SDSA with a small gauge atraumatic needle.
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Randomized Controlled Trial Clinical Trial
Withdrawal forces during removal of lumbar extradural catheters.
After performing successful continuous lumbar extradural conduction block, we investigated the effects of the extradural insertion technique (midline (M) or paramedian (P)) and patient position during extradural catheter removal (flexed lateral (L) or sitting (S)) on the force required to remove extradural catheters. One hundred parturients were allocated randomly to four groups: ML, MS, PL, PS. ⋯ However, more than 2.5 times as much force was required to remove the catheters when patients were in the flexed sitting compared with the lateral position (P < 0.005). For ease of removal of catheters from the lumbar extradural space we therefore strongly recommend the flexed lateral position.
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We studied 60 children undergoing neurosurgical procedures in the sitting position. Routine monitoring included ECG, pulse oximetry, invasive arterial pressure, in particular mean arterial pressure (MAP), and right atrial pressure (RAP). Children were allocated to two groups. ⋯ Inflation of the MAST suit induced a dramatic increase in RAP and JBVP, reinforced by addition of PEEP. There was a strong positive relationship between RAP and JBVP. There were no deleterious side effects or differences between the two groups in peroperative blood product requirements or surgical general conditions.(ABSTRACT TRUNCATED AT 250 WORDS)
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We have investigated the incidence of throat complaints 6-24 h after tracheal intubation in 1325 patients. Variables such as anaesthetic drug, intubation time, number of intubation attempts, gastric tube, sex and age were recorded. The incidence of sore throat was considerably lower (14.4%) compared with other reports in the literature and was significantly greater in females (17.0% vs 9.0%) and after thyroid surgery. The incidence of sore throat was not increased after multiple intubation attempts or after administration of suxamethonium or a non-depolarizing neuromuscular blocker.
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This study was designed to see if methylmethacrylate monomer bone cement released histamine in 13 patients undergoing total hip replacement surgery with a cemented prosthesis, compared with seven control patients receiving a cementless porous-coated prosthesis. Blood samples for plasma concentrations of histamine were obtained before the start of anaesthesia, immediately before insertion of methylmethacrylate bone cement into the shaft of the femur in the cemented fixation group or before insertion of the femoral component of the prosthesis in the cementless fixation group, and 15, 30 and 60 min after the start of implantation of the prosthesis. ⋯ There were no significant differences between groups. We conclude that methylmethacrylate bone cement does not release histamine during total hip replacement surgery.