British journal of anaesthesia
-
Randomized Controlled Trial Clinical Trial
Granisetron reduces the incidence of nausea and vomiting after middle ear surgery.
We studied the efficacy of granisetron, a selective 5-hydroxytryptamine type-3 receptor antagonist, in preventing postoperative nausea and vomiting (PONV) after middle ear surgery. In a randomized, double-blind, placebo-controlled study, 60 ASA I patients received placebo (saline) or granisetron 40 micrograms kg-1 i.v. immediately before induction of anaesthesia (n = 30 in each group). ⋯ There were no clinically important adverse effects in either group. We conclude that granisetron, given before anaesthesia, reduced the incidence of PONV after middle ear surgery.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Comparison between alfentanil, pethidine and placebo in the treatment of post-anaesthetic shivering.
We have compared the effects of pethidine, alfentanil and placebo in the treatment of post-anaesthetic shivering. Ninety patients who shivered after routine surgery were allocated randomly to receive normal saline (n = 30), alfentanil 250 micrograms (n = 30) or pethidine 25 mg (n = 30). ⋯ Alfentanil was not significantly different from normal saline in affecting shivering. We conclude that alfentanil 250 micrograms was not effective in the treatment of post-anaesthetic shivering.
-
Randomized Controlled Trial Clinical Trial
Influence of pulse oximeter lower alarm limit on the incidence of hypoxaemia in the recovery room.
In a prospective, randomized study, we have investigated the effects of two arbitrary pulse oximeter lower alarm limit (LAL) settings (90% = group 90, n = 320 and 85% = group 85, n = 327) on the incidence of hypoxaemia in the recovery room. In group 90, we calculated the theoretical effect of elimination of transient episodes of low pulse oximeter oxyhaemoglobin saturation (SpO2) by introducing a time delay between the onset of the alarm condition and triggering of the alarm. When only hypoxaemic episodes lasting more than 1 min were included, SpO2 < or = 90% occurred in 11% of patients in group 90 and in 20% in group 85 (relative risk (RR) 1.84, confidence interval (CI) 1.26-2.69; P < 0.01). ⋯ Introducing a theoretical delay of 15 s in group 90 between crossing the alarm threshold and triggering the alarm would have reduced the number of alarms by 60%. The results of the study suggest that decreasing the alarm limit in an attempt to reduce frequent false alarms may lead to an increase in more relevant episodes of hypoxaemia and setting the LAL at 85% cannot be recommended routinely. Introducing a 15 s delay in group 90 would reduce the number of alarms by the same amount as changing the LAL from 90% to 85%.
-
Case Reports
Thermal softening of tracheal tubes: an unrecognized hazard of the Bair Hugger active patient warming system.
The Bair Hugger system is a new and highly effective active patient warming system which produces a layer of warm air between the patient and the warming system. We report an instance of marked softening and distortion of a polyvinyl chloride tracheal tube caused by this layer. We also present laboratory data indicating that this is a likely problem under routine theatre conditions, with suggestions for prevention.
-
A retrospective review over 6 yr of patients presenting to the hand clinic was performed to identify cases of postoperative brachial plexopathy (PBP) and to assess both prognosis and early indices of prognosis. Over this period (1989-1995), 22 patients were referred by the hospital's surgical departments to the hand clinic because of PBP. Eight cases followed open heart surgery (OHS) and 14 followed non-cardiac surgery (NCS). ⋯ At a 1 week "prognostic milestone", 79% of NCS patients with significant symptomatology enjoyed complete recovery although this took as long as 5 months to 1 yr in 50% of patients. At a 6-8 week "prognostic milestone", 50% of those who had not yet had improvement in the motor deficit suffered residual neurological deficit. All patients recovered to a significant extent even when recovery was not complete and none suffered from late deterioration or chronic pain.