Anaesthesia and intensive care
-
Anaesth Intensive Care · May 1991
Randomized Controlled Trial Comparative Study Clinical TrialA comparison of two-lung high frequency positive pressure ventilation and one-lung ventilation plus 5 cm H2O non-ventilated lung CPAP, in patients undergoing anaesthesia for oesophagectomy.
A randomised prospective controlled study was conducted during a one-year period on patients scheduled for oesophagectomy via a right thoracotomy approach. Twenty-two patients received one-lung ventilation (OLV group) and twenty patients received high frequency positive pressure ventilation (HFPPV group). ⋯ The mean peak inspiratory pressure and average mean airway pressure were significantly lower in the HFPPV group 28.8 (SD 7.7) and 7.2 (SD 2.4) cm H2O respectively, compared with the OLV group, 40.0 (SD 9.9) and 11.9 (SD 4.9) cm H2O (P less than 0.05). Two-lung high frequency positive pressure ventilation has some advantages over one-lung ventilation during the thoracotomy phase of oesophagectomy because it is easy to administer, does not significantly compromise the surgical exposure and is associated with fewer severe undesirable physiological disturbances.
-
Anaesth Intensive Care · May 1991
Randomized Controlled Trial Clinical TrialThe influence of epidural pethidine on shivering during lower segment caesarean section under epidural anaesthesia.
A prospective study of 94 patients undergoing elective lower segment caesarean section under epidural anaesthesia was performed in order to determine the incidence of shivering and the influence of epidural pethidine. Epidural anaesthesia was established with bupivacaine 0.5% with adrenaline, with or without additional lignocaine 2% with adrenaline, to total 20-25 ml. With the injection of epidural local anaesthesia an extra 5 ml of solution was administered into the epidural space--pethidine 25 mg preservative-free, in normal saline, or normal saline alone. ⋯ The difference was highly significant (P less than 0.01). There was no significant difference in the incidence of maternal nausea, vomiting, drowsiness or pruritus, or neonatal Apgar scores. Cord blood samples were assayed for pethidine, revealing low or absent pethidine concentrations.
-
The use of epidural fentanyl by patient-controlled analgesia (PCA) may be a useful method of providing high-quality postoperative analgesia on the general surgical ward. The successful use of this technique requires an infusion pump with specific characteristics. Three Provider 5500, newly-developed, battery-powered PCA pumps, were tested to determine their accuracy, threshold of occlusion alarm limits and stored volume characteristics. ⋯ This problem did not occur with the addition of an epidural catheter and filter. This device has features which make it suitable for the safe delivery of epidural PCA. Care, however, needs to be taken on changing cartridges to prevent accidental administration of a drug bolus to the patient.
-
Anaesth Intensive Care · May 1991
Comparative StudyIntraoperative assessment of the Lawrence 3000 Doppler Cardiac Output Monitor.
Transoesophageal Doppler cardiac output measurement was evaluated against the thermodilution method in eleven patients undergoing elective cardiac surgery. A total of 106 pairs of Doppler and thermodilution values were obtained. Cardiac output was measured over a range of 2.3 l.min-1. to 11.51 l.min-1. ⋯ Standard deviction was 1.8 l.min-1. This is a significant difference. It is concluded that these techniques do not agree when measuring cardiac outputs.
-
Anaesth Intensive Care · May 1991
Experience with the laryngeal mask airway in two hundred patients.
Observations were recorded from two hundred consecutive insertions of the laryngeal mask airway (LMA). They were undertaken by 27 anaesthetists most of whom had no previous experience of its use. A clinically patent airway was obtained in 94% of patients and in the majority of these (76%) the LMA was positioned correctly at the first attempt. ⋯ Success with the LMA was related to experience: anaesthetists who had used the LMA over 15 times had no failures in 67 insertions. Twenty-two patients coughed and six developed mild laryngospasm at insertion. The incidence of postoperative sore throat was 8%.