Anaesthesia and intensive care
-
Anaesth Intensive Care · Oct 2000
Use of a fibreoptic stylet to visually evaluate tracheal intubation technique.
To compare the tracheal intubation by novices with that of instructors, we videotaped the view obtained through a fibreoptic stylet during standard tracheal intubations with a Macintosh direct laryngoscope. The duration of visualization of the vocal cords was longer during intubation by instructors than during trainee attempts. ⋯ The quality of the image of the vocal cords through the stylet was related to these video-view parameters. Our results demonstrated that visualization of the vocal cords by direct laryngoscope and manipulation of the tracheal tube in the oral cavity were different between anaesthesia trainees and instructors, and suggested that visually monitoring the tracheal intubation procedure through a fibreoptic stylet might be useful for the education of anaesthesia trainees.
-
Anaesth Intensive Care · Oct 2000
Randomized Controlled Trial Clinical TrialTiming of midazolam and propofol administration for co-induction of anaesthesia.
We aimed to determine the optimum timing of midazolam administration prior to propofol to achieve the maximal reduction in the dose of propofol required to induce anaesthesia. Female (ASA 1-2) patients, aged 18 to 45 years, weighing 40 to 75 kg and scheduled for gynaecological surgery were eligible for the study. Consenting patients were randomly assigned to six groups. ⋯ There was no significant (P = 0.14) difference in propofol ED50 among the five groups which received midazolam. Patients who received midazolam had less recollection of events surrounding induction (P < 0.001) and recalled the induction experience as being more pleasant (P = 0.03) than those who did not receive midazolam. These results indicate that midazolam may be given up to 10 minutes prior to propofol and still achieve a substantial dose reduction.
-
Anaesth Intensive Care · Oct 2000
Randomized Controlled Trial Clinical TrialThe effect of adding fentanyl to ropivacaine 0.125% on patient-controlled epidural analgesia during labour.
The use of patient-controlled epidural analgesia (PCEA) for labour analgesia is rapidly gaining acceptance. However, the ideal PCEA solution and PCEA program remains uncertain. We studied the effect of adding fentanyl 2 micrograms/ml on demand-only PCEA using ropivacaine 0.125% for labour analgesia. ⋯ The ratio of successful PCEA demand to total number of demands, the satisfaction score and the maternal-fetal outcome were similar in both groups. In conclusion, the addition of fentanyl had a dose-sparing effect on the requirement of ropivacaine. This PCEA regimen produced a low incidence of motor block, good labour pain relief and excellent patient satisfaction.
-
Anaesth Intensive Care · Oct 2000
Randomized Controlled Trial Clinical TrialDoes adrenaline improve epidural bupivacaine and fentanyl analgesia after abdominal surgery?
The alpha-adrenergic agonists have been demonstrated to have synergistic effects with opioids and local anesthetics in animal research. The present study was performed to determine whether the addition of adrenaline improves the analgesic effects of an epidural infusion of a combination of fentanyl and bupivacaine after abdominal surgery. We studied 90 ASA 1 or 2 patients scheduled for abdominal surgery under epidural anaesthesia, with or without general anaesthesia. ⋯ The number of additional analgesics and incidence of side-effects did not differ between groups. In conclusion, the results of the present study demonstrate that the addition of adrenaline to a combination of fentanyl and bupivacaine improves the quality of epidural analgesia after abdominal surgery. Under the conditions of the study, we did not detect any disadvantage from the addition of adrenaline.
-
This study examined the efficacy of a technique of administration of lignocaine 2% (with 1:200,000 adrenaline) to the nose, pharynx and larynx. A simple device constructed from a 22 gauge Optiva cannula attached to a medical oxygen supply via green "bubble" tubing and the barrel of a 3 ml syringe, similar to that described by Mackenzie, was used to administer aerosolized lignocaine initially via the nose and subsequently via a nasopharyngeal airway. Ten unsedated, unpremedicated volunteers were intubated. ⋯ Intubating conditions were good and the procedure was well tolerated in all subjects. The mean dose of lignocaine was 4.8 mg.kg-1 (range 2.7 to 6.9 mg.kg-1) and plasma concentrations were well below toxic levels (highest concentration 3.12 mg.l-1). There was good haemodynamic stability and no episode of oxyhaemoglobin desaturation.