British journal of anaesthesia
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Randomized Controlled Trial Comparative Study
Efficacy of intravenous acetaminophen and lidocaine on propofol injection pain.
Different methods and propofol formulations have been used to decrease propofol injection pain, but it remains an unresolved problem. We aimed to investigate the effect of i.v. acetaminophen pretreatment on the propofol injection pain. ⋯ Pretreatment with i.v. acetaminophen seems to be effective in attenuating pain during i.v. injection of propofol.
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This review discusses sedation for regional anaesthesia in the adult population. The first section deals with general aspects of sedation and shows that the majority of patients receiving sedation for regional anaesthesia are satisfied and would choose it again. ⋯ The techniques for administering sedation are discussed and replacement of the traditional repeated boluses or continuous infusion with pharmacokinetic and patient-controlled systems is supported. Patient satisfaction studies suggest that patient-controlled systems are preferred.
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Randomized Controlled Trial
Randomized controlled trial of patient-controlled epidural analgesia after orthopaedic surgery with sufentanil and ropivacaine 0.165% or levobupivacaine 0.125%.
Ropivacaine, and to a lesser extent also levobupivacaine, is commonly used for postoperative epidural analgesia. Despite ED50 data suggesting a potency difference between these drugs, clinically they can be difficult to distinguish. As a consequence, it is unclear which concentration of each drug to use when comparing them for long-term analgesia. ⋯ Both local anaesthetics provided effective postoperative analgesia but, even in a 25% weaker concentration, a small volume of levobupivacaine and opiate substance was consumed. These differences may be explained by a potency difference or by the duration of action of levobupivacaine.
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Randomized Controlled Trial
Upper cervical spine movement during intubation: fluoroscopic comparison of the AirWay Scope, McCoy laryngoscope, and Macintosh laryngoscope.
The AirWay Scope (AWS) is a new fibreoptic intubation device, which allows visualization of the glottic structures without alignment of the oral, pharyngeal, and tracheal axes, and thus may be useful in patients with limited cervical spine (C-spine) movement. We fluoroscopically evaluated upper C-spine movement during intubation with the AWS or Macintosh or McCoy laryngoscope. ⋯ Compared with the Macintosh or McCoy laryngoscope, the AWS produced less movement of upper C-spine for intubation in patients with a normal C-spine.
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Review
Anaesthesia chapter from Saving mothers' lives; reviewing maternal deaths to make pregnancy safer.
This chapter concerning maternal mortality due to anaesthesia, reprinted with permission from Saving Mothers' Lives, is the 18th in a series of reports within the Confidential Enquiries into Maternal and Child Health (CEMACH) in the UK. In the years 2003-05 there were six women who died from problems directly related to anaesthesia, which is the same as the 2000-02 triennium. Obesity was a factor in four of these women who died. ⋯ Other cases could be categorized into poor recognition of women being sick and poor clinical management of haemorrhage, sepsis and of pre-eclampsia. Early warning scores of vital signs may help identify the mother who is seriously ill. Learning points are highlighted in relation to the clinical management of these obstetric complications.