British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Removal of the laryngeal mask airway in children: anaesthetized compared with awake.
We studied 60 children, aged 12 months to 8 yr, undergoing plastic surgery under general anaesthesia supplemented by regional anaesthesia. Patients were allocated randomly to have the laryngeal mask airway removed either on awakening or while anaesthetized. ⋯ There were no differences in the incidences of laryngospasm, desaturation (< 95%) and excess salivation between the groups. Removed of the laryngeal mask airway during deep anaesthesia reduced coughing in the immediate postoperative period.
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Randomized Controlled Trial Comparative Study Clinical Trial
Sevoflurane-nitrous oxide or halothane-nitrous oxide for paediatric bronchoscopy and gastroscopy.
We have studied 120 infants and children, in three age groups (3-11 months, 1-5 yr and 6-15 yr), to compare anaesthesia with sevoflurane or halothane for bronchoscopy or gastroscopy, or both. Premedication or i.v. anaesthetic agents were not used. Patients were allocated randomly to receive either 7% sevoflurane or 3% halothane in 66% nitrous oxide in oxygen for induction of anaesthesia. ⋯ Physiological and psychomotor recovery were more rapid after sevoflurane than after halothane. At 24-h follow-up, children who received sevoflurane had significantly less nausea and vomiting. We conclude that sevoflurane was superior to halothane for paediatric bronchoscopy and gastroscopy.
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Clinical Trial
Continuous extrapleural paravertebral infusion of bupivacaine for post-thoracotomy analgesia in young infants.
We have studied the efficacy of a continuous paravertebral infusion of bupivacaine for the management of post-thoracotomy pain in 20 infants with a median age of 5.3 weeks (range 2 days to 20 weeks). Immediately before chest closure, 0.25% bupivacaine 1.25 mg kg-1 was injected into an extrapleural paravertebral catheter, inserted under direct vision. A continuous infusion of 0.25% bupivacaine 0.5 mg kg-1 h-1 was commenced 1 h later and terminated after 24 h. ⋯ The technique provided effective postoperative pain relief in 18 (90%) patients and the failure in two (10%) infants was attributed to catheter block. Mean maximum serum concentrations of bupivacaine after the loading dose and during infusion were 1.03 (SD 0.56) and 2.00 (0.63) microgram ml-1, respectively. There were no major complications relating to the technique and we conclude that extrapleural paravertebral block is a simple and effective method for post-thoracotomy analgesia in young infants.
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Randomized Controlled Trial Clinical Trial
Haemostatic changes caused by i.v. regional anaesthesia with lignocaine.
The various components of i.v. regional anaesthesia (IVRA), that is ischaemia, tourniquet compression and the presence of high concentrations of local anaesthetics in the blood vessels of the extremity, may affect haemostatic mechanisms. We performed a cross-over study in 10 healthy male volunteers to examine the role of lignocaine in IVRA on several haemostatic variables, and those indicating fibrinolysis and platelet function in particular. Venous blood samples were obtained from the test arm and the opposite arm before IVRA, at the time of tourniquet cuff deflation and 30 min thereafter. ⋯ Although IVRA appeared to induce some platelet dysfunction, there was a small increase in TEG amplitude indicative of improved fibrin-platelet interaction in the lignocaine-exposed arm at the time of cuff deflation. We conclude that the presence of high i.v. lignocaine concentrations (median 144.4 micrograms ml-1 in cubital veins at the end of the tourniquet time) potentiated ischaemia-induced fibrinolysis activation during IVRA. Concomitant platelet dysfunction was not aggravated by lignocaine.
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Randomized Controlled Trial Comparative Study Clinical Trial
Efficiency of a circle system for short surgical cases: comparison of desflurane with isoflurane.
Patients undergoing short surgical procedures but requiring ventilation of the lungs were allocated randomly to receive either desflurane or isoflurane by circle absorption system, initially at a high fresh gas flow. The inspired and expired concentrations of the volatile agent were measured and the fresh gas flows reduced to low flow (500 ml min-1 total when FE/FI = 0.8), as measured on a multigas analyser. In patients receiving desflurane (n = 32), the median time at which flows were reduced was 5 min (interquartile range (IQR) 1 min) while with isoflurane (n = 32), the median time was 19 (IQR 12) min. ⋯ In the isoflurane group the concentration continued to decrease during anaesthesia. In the desflurane group the initial decrease was followed by a slow recovery. We conclude that the circle system can be used efficiently for short anaesthetics using desflurane.