Anaesthesia and intensive care
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Anaesth Intensive Care · Aug 1997
Randomized Controlled Trial Comparative Study Clinical TrialLaryngeal mask insertion following inhalational induction in children: a comparison between halothane and sevoflurane.
The aim of this study was to compare laryngeal mask insertion conditions following inhalational induction with either halothane or sevoflurane. Fifty-eight healthy children scheduled for dental extraction were randomly assigned to receive nitrous oxide 66% in oxygen and 3.0 MAC of either halothane or sevoflurane introduced in a stepwise fashion. The laryngeal masks were inserted when an adequate depth of anaesthesia was attained and the reactions and time to insertion noted. ⋯ The conditions for laryngeal mask insertion were generally good with 86.2% and 89.2% in the halothane and sevoflurane groups respectively having had no reactions to insertion. The complications to laryngeal mask insertion encountered were mild. The emergence time from the anaesthetic was found to be shorter for sevoflurane but the difference was not statistically significant.
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Anaesth Intensive Care · Aug 1997
Randomized Controlled Trial Clinical TrialThe effect of supplemental oxygen on the incidence of hypoxaemia after premedication in patients undergoing cardiac surgery.
Opiate premedication may cause significant respiratory depression, particularly when other sedative agents such as scopolamine or benzodiazepines are added. This can cause hypoxaemia with potential for worsening myocardial ischaemia in cardiac surgery patients. The aim of this study was to investigate the incidence of hypoxaemia (SpO2 < 90%) in elective patients undergoing cardiac surgery and to assess the efficacy of supplemental oxygen in preventing it. ⋯ In patients receiving oxygen (n = 48) there were no episodes of hypoxaemia (0%). In patients not receiving oxygen (n = 46) there were 14 episodes of hypoxaemia (30%, P < 0.0001). We conclude that there is a significantly high incidence of hypoxaemia in cardiac surgery patients following combined opiate and sedative premedication and that it can be reduced by the routine administration of supplemental oxygen.
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Anaesth Intensive Care · Aug 1997
Polyurethane central venous catheters, hydrochloric acid and 70% ethanol: a safety evaluation.
Three groups of polyurethane central venous catheters (CVC) were infused daily for twenty days with 0.1 normal hydrochloric acid, 70% ethanol and normal saline (control) respectively to look for any changes in microscopic structural integrity. A 1 cm segment was cut from the distal end of each CVC daily. All sections were examined in a scanning electron microscope, looking for evidence either of damage to the lumen surface or of wall thinning. ⋯ Sporadic fine surface-pitting appeared late in the study without any clear temporal or treatment-related pattern. The mean CVC wall thickness did not change significantly over the study period (P = 0.15). Qualitative softening of ethanol treated catheters was observed, and this finding limits the recommendations for the use of ethanol. 0.1N HCl does not compromise the structural safety of the catheters, and its use should be considered when polyurethane CVC. become occluded.
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Anaesth Intensive Care · Aug 1997
Continuous extrapleural intercostal nerve block for post thoracotomy analgesia in children.
The safety and efficacy of continuous extrapleural intercostal nerve block has been well established in adults. This review of our initial paediatric experience suggests a role for this technique in children and discusses risks and benefits relative to other forms of regional analgesia for thoracotomy. Nine children aged one to twelve years received extrapleural infusions of bupivacaine 0.1-0.2% following lateral thoracotomy for lung resection. ⋯ Postoperative nausea and vomiting and respiratory depression were not observed in any patient and all were able to comply with physiotherapy. There were no complications of catheter placement or bupivacaine administration. Our initial experience suggests that this is a safe technique which minimizes complementary opioid administration and provides adequate analgesia for children postthoracotomy for lung resection.