British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Attenuation of haemodynamic responses to tracheal intubation by the styletscope.
Tracheal intubation often causes a haemodynamic response probably generated by direct laryngoscopy. The StyletScope is a new intubation device that does not require direct laryngoscopy. We prospectively measured haemodynamic changes after tracheal intubation using the StyletScope. The increase of heart rate was less during tracheal intubation with the StyletScope when compared with the Macintosh laryngoscope.
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Randomized Controlled Trial Comparative Study Clinical Trial
Sevoflurane EC50 and EC95 values for laryngeal mask insertion and tracheal intubation in children.
The laryngeal mask airway (LMA) is a simple, easy to use and safe method for airway control in children. Its insertion needs less anaesthetic, and haemodynamic responses and postoperative sequelae are less than with laryngoscopy and tracheal intubation. This study was designed to determine the end-tidal concentrations of sevoflurane where 50% (EC50) and 95% (EC95) of the attempts to secure the airway would be successful. ⋯ Sevoflurane provided good conditions for both LMA insertion, and laryngoscopy and tracheal intubation without serious adverse effects. The EC50 and the EC95 of sevoflurane were 1.57 (SD 0.33)% and 2.22% for LMA insertion and 2.20 (SD 0.31)% and 2.62% for laryngoscopy and tracheal intubation. Thus, less sevoflurane is required for LMA insertion in children than for laryngoscopy and tracheal intubation.
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Randomized Controlled Trial Comparative Study Clinical Trial
Spinal anaesthesia with ropivacaine 5 mg ml(-1) in glucose 10 mg ml(-1) or 50 mg ml(-1).
Forty patients undergoing spinal anaesthesia for a variety of surgical procedures were randomly allocated to receive 3 ml of ropivacaine 5 mg ml(-1) in glucose 10 mg ml(-1) or 50 mg ml(-1). Onset of sensory block to T10 was significantly faster (P=0.03) with the glucose 50 mg ml(-1) solution (median 5 min, range 2-20 min) than with the 10 mg ml(-1) solution (median 10 min, range 2-25 min). ⋯ Complete motor block was produced in the majority of patients (10 mg ml(-1) 90%; 50 mg ml(-1) 85%) and the time to complete regression was the same in both groups (median 120 min, range 90-210 min). A block adequate for the projected surgery was achieved in all patients.
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Randomized Controlled Trial Clinical Trial
Epidural analgesia and arterial reconstructive surgery to the leg: effects on fibrinolysis and platelet degranulation.
It has been suggested that the incidence of early graft occlusion after arterial reconstructive surgery to the leg may be decreased by epidural analgesia. This effect may be mediated by the suppression of the usual cortisol response to surgery, which results in increased circulating plasminogen activator inhibitor-1 with consequent adverse effects on fibrinolysis. To investigate this and other potential mechanisms, 30 patients undergoing arterial reconstructive surgery to the leg were randomized to receive either general anaesthesia or general anaesthesia plus epidural analgesia. ⋯ Interleukin-6 values increased significantly in both groups after 4 h and remained elevated until day 3. There were no significant differences between the groups in any variable measured. We conclude that any effect of epidural analgesia on early graft patency is unlikely to be mediated by fibrinolysis or platetlet degranulation.
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Comparative Study
Effect of common airway manoeuvres on upper airway dimensions and clinical signs in anaesthetized, spontaneously breathing children.
Chin lift, jaw thrust and these manoeuvres combined with continuous positive airway pressure (CPAP) can be used to improve the patency of the upper airway during general anaesthesia. We used video endoscopy and measurement of stridor to compare the efficacy of these manoeuvres in 24 children (3-10 yr) with adenotonsillar hyperplasia. ⋯ Both chin lift plus CPAP and jaw thrust plus CPAP reduced stridor significantly compared with the unsupported condition. In conclusion, in spontaneously breathing children with large tonsils, chin lift plus CPAP is recommended, whereas jaw thrust plus CPAP is no better and may cause post-operative discomfort.