Anaesthesia and intensive care
-
Surgeons, anaesthetists and intensivists need to be reminded of an alternative to tracheostomy in the management of patients with severe maxillofacial injuries. The technique and indications for submental intubation are described.
-
Anaesth Intensive Care · Apr 2000
Randomized Controlled Trial Comparative Study Clinical TrialIntubation conditions and postoperative myalgia in outpatient dental surgery: a comparison of succinylcholine with mivacurium.
Ninety-four patients undergoing elective outpatient third molar extraction were recruited into a double-blind, randomized, prospective trial comparing mivacurium (group M) with succinylcholine (Group S) for conditions for endotracheal intubation and the occurrence of postoperative myalgia. Anaesthesia was induced with fentanyl 1 microgram.kg-1 and propofol 2.5 micrograms.kg-1 in all patients. Group S patients were given gallamine 20 mg while group M patients were given mivacurium 0.2 mg.kg-1. ⋯ Intubating conditions in group M were significantly better than those in group S (P < 0.001). The incidence of postoperative myalgia was 9.5% in group M and 26% in group S but this was not statistically significant (P = 0.09). We propose that mivacurium is a suitable neuromuscular blocker to use for endotracheal intubation in outpatient dental surgery.
-
Damage to teeth is the most common complaint against anaesthetists. A dental history and oral examination are important before anaesthesia. Pre-existing dental pathology or the presence of prostheses makes damage more likely but sound teeth may be affected. ⋯ Custom mouthguards can be useful. A management plan can help control losses if damage does occur. Patients should be warned about the possibility of dental trauma.
-
Anaesth Intensive Care · Apr 2000
Immunoassays in the diagnosis of anaphylaxis to neuromuscular blocking drugs: the value of morphine for the detection of IgE antibodies in allergic subjects.
Radioimmunoassays (RIAs) for IgE antibodies to specific neuromuscular blocking drugs (NMBDs) are an important tool in the diagnosis of anaphylaxis during anaesthesia although they are performed in only a few laboratories throughout the world. NMBDs bind to antibodies by their substituted ammonium ions. ⋯ The morphine RIA proved to be both a more sensitive and efficient test for the detection of IgE antibodies to NMBDs than the specific NMBD RIAs. We have adopted the morphine RIA in our laboratory in preference to the specific RIAs and predict that use of this single assay will become widespread for the in vitro diagnosis of allergic sensitivities to NMBDs.
-
Anaesth Intensive Care · Apr 2000
The dose-effect relationship for morphine and vomiting after day-stay tonsillectomy in children.
A dose-response curve for intravenous morphine and vomiting was investigated in children having day-stay tonsillectomy. A retrospective chart review was performed for the 164 children fulfilling the inclusion criteria. Morphine (mean 0.09 mg/kg SD 0.05) was used in 108 children in the perioperative period and a further 56 children were given no opioid. ⋯ Satisfactory postoperative analgesia in children has been reported with morphine 0.05 to 0.15 mg/kg. Doses above 0.1 mg/kg are associated with a greater than 50% incidence of vomiting. Our data suggests that lower doses of morphine are associated with a decreased incidence of emesis after tonsillectomy in children.