British journal of anaesthesia
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Randomized Controlled Trial
Effectiveness of continuous wound infusion of 0.5% ropivacaine by On-Q pain relief system for postoperative pain management after open nephrectomy.
Block of parietal nociceptive afferent nerves using continuous wound infiltration with local anaesthetics may be beneficial in multimodal postoperative pain management. The effectiveness of continuous wound infusion of ropivacaine for postoperative pain relief after open nephrectomy was analysed in a prospective, randomized, double-blinded, placebo-controlled trial. ⋯ Continuous surgical wound infusion with ropivacaine improved pain relief and accelerated recovery and discharge reducing overall costs of care.
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Randomized Controlled Trial Comparative Study
Airway scope and gum elastic bougie with Macintosh laryngoscope for tracheal intubation in patients with simulated restricted neck mobility.
/st> Airway Scope is a new videolaryngoscope which requires less cervical movement during intubation than direct laryngoscopy. Thus, in patients wearing a rigid cervical collar, we compared the efficacy of the Airway Scope and the gum elastic bougie with Macintosh laryngoscope during tracheal intubation. ⋯ /st> The Airway Scope shortens intubation time, is less likely to result in oesophageal intubation, and may offer a marginally higher intubation success rate in patients with simulated restricted neck mobility.
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Review Case Reports
Convulsions after ropivacaine 300 mg for brachial plexus block.
A healthy 18-yr-old male (weight 60 kg, height 167 cm), with a history of febrile convulsions in childhood, developed a grand mal convulsion 10 min after the second of two injections of ropivacaine 150 mg, both given incrementally 15 min apart (total 300 mg), for combined axillary/interscalene brachial plexus block. Treatment was with oxygen, lung ventilation, and i.v. midazolam, and the patient made a complete recovery. ⋯ Whether sub-clinical EEG changes identified after operation were related to this sensitivity cannot be determined, but review illustrates wide variation in both the dose and the plasma concentration of local anaesthetics associated with systemic toxicity. The UK recommended dose of ropivacaine for brachial plexus block is 225-300 mg according to stature.
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Single-lung ventilation (SLV) during thoracic surgery causes important cardiopulmonary disturbances. Absolute cerebral oximetry was used to determine the incidence and magnitude of the decrease in cerebral oxygen saturation (Sct(o(2))) in patients undergoing SLV during thoracic surgery. ⋯ Thoracic surgery with SLV seems to be associated with a significant decrease of Sct(o(2)) in the majority of patients. Parameters such as peripheral oxygen saturation or Po(2) which are used to guide SLV during thoracic surgery are not sufficient to detect significant cerebral oxygen desaturations.
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Retrobulbar anaesthesia allows eye surgery in awake patients. Severe complications of the blind techniques are reported. Ultrasound-guided needle introduction and direct visualization of the spread of local anaesthetic may improve quality and safety of retrobulbar anaesthesia. Therefore, we developed a new ultrasound-guided technique using human cadavers. ⋯ Our new ultrasound-guided technique has the potential to improve safety and efficacy of the procedure by direct visualization of the needle placement and the distribution of the injected fluid. Furthermore, the precise injection near the optic nerve could lead to a reduction of the amount of the local anaesthetic needed with fewer related complications.