British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Rapid tracheal intubation with propofol, alfentanil and a standard dose of vecuronium.
We studied 60 ASA I patients with Mallampati grade 1 airways to compare emergency intubating conditions with either alfentanil 20 micrograms kg-1, propofol 2.5 mg kg-1 and vecuronium 0.1 mg kg-1, or with thiopentone 5 mg kg-1 and suxamethonium 1 mg kg-1. Ease of laryngoscopy, vocal cord status and cough response were graded. The trachea of all patients was intubated; 83% of patients in the alfentanil-propofol-vecuronium group and 86% in the thiopentone-suxamethonium group were considered to have satisfactory intubating conditions at 60 s. We conclude that the combination of alfentanil 20 micrograms kg-1, propofol 2.5 mg kg-1 and vecuronium 0.1 mg kg-1 provided adequate conditions for rapid tracheal intubation.
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Randomized Controlled Trial Comparative Study Clinical Trial
Laryngeal mask airway and uncuffed tracheal tubes are equally effective for low flow or closed system anaesthesia in children.
Low flow and closed system anaesthesia have considerable advantages in economy, limited atmospheric pollution, and maintenance of humidification and temperature. To benefit from these techniques leakage from the breathing system should be as low as possible. The sealing of the airway is crucial to ensure this. ⋯ Ventilation was adequate in all cases with both devices. Loss of gas from the breathing system was less than 100 ml min-1 in 13 (87%) patients in the LMA and in 12 (80%) patients in the TT group, with a maximum of approximately 700 ml min-1 in the TT and approximately 350 ml min-1 in the LMA group. We conclude that the airway sealing with both devices was tight enough to perform low flow or closed system anaesthesia in paediatric patients aged 2-6 yr.
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Clinical Trial
Metabolic, biochemical and haemodynamic effects of infusion of propofol for long-term sedation of children undergoing intensive care.
We have studied prospectively, in nine children requiring sedation to facilitate mechanical ventilation, the metabolic, biochemical and haemodynamic effects of infusion of propofol. Children were given infusions of propofol 1-4mg kg-1 h-1 and fentanyl 1-5 micrograms kg-1 h-1 for 48 h. Heart rate, arterial pressure, central venous pressure, fluid balance and urine output were recorded hourly and sedation scores every 4 h. ⋯ Under these very proscriptive conditions we did not encounter lipaemia or acidosis with infusion of propofol. Thus propofol may be a safe sedative agent for use in paediatric intensive care if used appropriately. Further large scale studies are needed to determine if warnings against the use of this agent in paediatric intensive care units are justified.
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Three patients in whom difficult tracheal intubation was expected but awake fibreoptic intubation was not feasible presented for head and neck surgery. Anaesthesia was induced rapidly and smoothly by inhalation of sevoflurane followed by fibreoptic or conventional tracheal intubation.
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A typical case of transient radicular irritation after spinal anaesthesia with 2% isobaric lignocaine is described. The definition and history of this syndrome and the implications of the use of pencil point needles with lignocaine for spinal anaesthesia are discussed.