Anaesthesia and intensive care
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Anaesth Intensive Care · Oct 1995
Randomized Controlled Trial Comparative Study Clinical TrialProspective clinical evaluation of two combined spinal-epidural kits.
One hundred combined spinal epidural kits (Portex, n = 51, Mallinckrodt, n = 49) were evaluated clinically by twelve anaesthetists with respect to performance of the loss-of-resistance syringe, epidural needle and spinal needle, and success in establishing single-segment combined spinal-epidural anaesthesia for caesarean section. Similar components included a plastic loss-of-resistance device, a Tuohy epidural needle, 26 or 27 gauge pencil-point spinal needle and closed end, three-lateral-eye epidural catheter. The Mallinckrodt kit incorporated a "back-eye" design for exit of the spinal needle from the epidural needle. ⋯ Most anaesthetists preferred the Mallinckrodt kit packaging and the Portex loss-of-resistance syringe, although the latter may have been biased by familiarity with this device. The portex spinal needle was more likely to be felt penetrating the dura (P = 0.02) and aspiration of cerebrospinal fluid was more frequently described as easy (P = 0.01). The most common criticisms of both kits were difficulty controlling the spinal needle position after entry into the subarachnoid space and subjectively, a high degree of resistance to injection through the spinal needle.
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Anaesth Intensive Care · Oct 1995
Randomized Controlled Trial Comparative Study Clinical TrialPostspinal headache in Taylor's approach: a comparison between 21- and 25-gauge needles in orthopaedic patients.
A randomized study was carried out on 160 patients aged 30-60 years with the aim of finding a method of preventing postdural puncture headache (PDPH). In Taylor's lumbosacral approach to the subarachnoid space, two different needle sizes were used (21-gauge versus 25-gauge) for injecting the anaesthetic solution. ⋯ Patients with PDPH showed mild symptoms which disappeared in a short time and none needed epidural blood patching. The possibility of using larger needles, facilitating the execution of the block without increasing PDPH incidence, renders this technique particularly attractive in patients where the midline approach is not feasible, or when pencil-point needles are not available.
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Anaesth Intensive Care · Oct 1995
Meta AnalysisA meta-analysis on the efficacy of epidural corticosteroids in the treatment of sciatica.
The efficacy of epidural corticosteroids in the treatment of sciatica was investigated by meta-analysis of all randomized controlled trials. Eleven suitable trials of good quality were identified involving a total of 907 patients. The use of epidural (caudal or lumbar) steroid in the short-term (up to 60 days) increased the odds ratio (OR) of pain relief ( > 75% improvement) to 2.61 (95% CI 1.90-3.77) when compared with placebo. ⋯ Adverse events included dural tap (2.5%), transient headache (2.3%) and a transient increase in pain (1.9%). There were no reported longterm adverse events. In conclusion we present quantitative evidence from meta-analysis of pooled data from randomized trials that epidural administration of corticosteroids is effective in the management of lumbosacral radicular pain.
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Anaesth Intensive Care · Oct 1995
Randomized Controlled Trial Clinical TrialEffect of propofol infusion on the endocrine response to cardiac surgery.
The effect of propofol infusion on the stress response was studied in patients undergoing coronary artery bypass graft (CABG). Ten patients received propofol infusion during cardiopulmonary bypass (CPB) and ten controls received diazepam. ⋯ There was a significant reduction in all three hormones (P < 0.05) in the study group. In addition, the amount of sodium nitroprusside used during CPB was significantly reduced (P < 0.05).
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Anaesth Intensive Care · Oct 1995
The perioperative system: a new approach to managing elective surgery.
A Perioperative Service has recently been introduced at liverpool hospital, a 460-bed university teaching hospital. This provides a co-ordinated system for managing all elective surgical patients from the time an admission booked until hospital discharge. This paper describes the patient assessment, structure and staff requirements, benefits of and problems encountered with this service. ⋯ There has been a reduction in the areas of cancellations due to unavailability of beds, inappropriate preparation of patients, and non-attendance of patients for booked procedures. Patient acceptance is high. The existence of a perioperative system facilitates the planning and management of elective surgery with maximum quality and efficiency.