Anaesthesia and intensive care
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Anaesth Intensive Care · Dec 1994
Training, skills and approach to potentially difficult anaesthesia in general practitioner anaesthetists.
Seventy-six of the 92 practising South Australian rural general practitioner anaesthetists responded to a questionnaire on anaesthetic training, skills and approach to potentially difficult anaesthesia. The mean training period in anaesthesia was 7.5 months, 24% at registrar level. Eight per cent had no training, and 40% had 3 months or less. ⋯ Patients classified as ASA grade 3 to 5, disease states such as unstable angina, severe asthma, and risk factors such as skeletal myopathy, were avoided by most general practitioners. The failed intubation rate was 50/10,000. The conclusion is that South Australian general practitioner anaesthetists exhibit a generally safe approach to selection of patients for anaesthesia, although in some instances the approach to potentially difficult anaesthesia should be more conservative.
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Anaesth Intensive Care · Dec 1994
Comparative StudyThe incendiary characteristics of the laryngeal and reinforced laryngeal mask airway to CO2 laser strike--a comparison with two polyvinyl chloride tracheal tubes.
The incendiary characteristics of the laryngeal and reinforced laryngeal mask airway to the CO2 laser have been compared with two polyvinyl chloride tracheal tubes. Three different power densities (2.35, 4.7 and 9.8 x 10(3) watt/cm2) were used, with either oxygen or a 30% oxygen/70% nitrous oxide mixture flowing down the tube. The laryngeal mask airway (and reinforced model) was shown to be more resistant than the polyvinyl chloride tracheal tubes. ⋯ At this power density the polyvinyl chloride tube ignited in 2 to 8 seconds and the cuff was penetrated in 0.1 seconds. At the highest power density the tubes of all airways ignited within 0.2 seconds. The possibilities for improving the incendiary characteristics of the laryngeal mask airway are discussed.
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Anaesth Intensive Care · Dec 1994
Randomized Controlled Trial Comparative Study Clinical TrialComparison of patient-controlled analgesia and nurse-controlled infusion analgesia after cardiac surgery.
A randomized, controlled clinical trial was conducted on 72 patients undergoing elective cardiac surgery to compare patient-controlled analgesia (PCA) to nurse-titrated infusion of morphine. Pain and nausea scores were assessed at 5, 20, 32 and 44 hours after cardiopulmonary bypass. Serum cortisol estimations were performed at 24 and 48 hours, and morphine consumption was measured at 0-24 and 24-48 hours. ⋯ There was a significant association between pain and serum cortisol at 48 hours (P = 0.023). This study also found a tenfold difference in the amount of morphine used (range = 11 to 108 mg), with no significant association with patient age or sex. We could find no significant benefit from the routine use of PCA in cardiac surgical patients.
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Anaesth Intensive Care · Dec 1994
Randomized Controlled Trial Clinical TrialPeritonsillar infiltration with bupivacaine for paediatric tonsillectomy.
In a double-blind study forty-two children scheduled for elective adenotonsillectomy were randomized to receive peritonsillar infiltration, following induction of anaesthesia, with either 0.25% plain bupivacaine or 0.9% saline, 0.5 ml/kg to a maximum of 10 ml. The children were assessed on awakening, and then 10 minutes, 1 hour, 4 hours and 24 hours later. ⋯ Thereafter there was no difference between the groups. The authors conclude that peritonsillar infiltration with bupivacaine is only moderately useful as analgesia for children having tonsillectomy.