British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Antiemetic prophylaxis in cardiac surgery: comparison of metoclopramide and ondansetron.
We have compared the effectiveness of ondansetron (115 patients) and metoclopramide (101 patients) for prevention of postoperative nausea and vomiting in patients undergoing cardiac surgery involving cardiopulmonary bypass. In a prospective, randomized, controlled, double-blind study, patients received oral ondansetron 16 mg or oral metoclopramide 10 mg, 1-2 h before surgery. ⋯ Compared with the metoclopramide group, the ondansetron group had a higher incidence of nausea (49.6% vs 33.7%; P < 0.05) and vomiting (42.6% vs 24.8%; P < 0.01). There was no difference between groups in the number of patients who accepted postoperative antiemetics (ondansetron 43.4% vs metoclopramide 32.6%) and there was no difference in the incidence of symptoms of moderate or severe nausea.
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Comparative Study
Improving the shape and compliance characteristics of a high-volume, low-pressure cuff improves tracheal seal.
A prototype design of a compliant latex, high-volume, low-pressure cuffed tracheal tube cuff (CHVLP) was compared with the Mallinckrodt Hi-Lo, Sheridan preformed and Portex Profile high-volume, low-pressure (HVLP) cuffed tracheal tubes for leakage of dye placed above the cuff in a benchtop mechanical ventilation model and in five isolated pig tracheas. There was no leakage in the ventilation model or in the pig tracheas with the prototype CHVLP. There was rapid leakage in the ventilation model and in all the pig tracheas for the Mallinckrodt Hi-Lo, the Sheridan preformed and the Portex Profile cuffs. This benchtop study suggests that improved HVLP cuff compliance characteristics may be beneficial in the prevention of leakage of fluid to the lungs known to occur with HVLP cuffs.
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Case Reports
Malposition of the epiglottis after tracheal intubation via the intubating laryngeal mask.
The intubating laryngeal mask has been reported to be a successful method of tracheal intubation although advancement of the tracheal tube via the laryngeal inlet into the trachea cannot be seen. Damage to the larynx or other tissues may occur during blind passage of a tracheal tube. We report a case in which the tracheal tube, advanced blindly, tucked the epiglottis into the laryngeal inlet, resulting in oedema of the epiglottis. This case illustrates the potential for airway obstruction after extubation when using the intubating laryngeal mask as a blind intubation guide.
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The transient hyperaemic response (THR) of blood flow velocity in the middle cerebral artery (vmca), measured by transcranial Doppler ultrasonography (TCD), can be used to assess cerebral autoregulation. We have studied the effects of propofol administered by target-controlled infusion on vmca, THR and carbon dioxide reactivity. We studied 20 healthy adult patients undergoing elective surgery. ⋯ Propofol caused a significant decrease in vmca but indices of autoregulation, THR ratio and strength of autoregulation increased significantly. Propofol had no effect on carbon dioxide reactivity. These results suggest that propofol may have a beneficial effect on cerebral haemodynamics.