Anaesthesia and intensive care
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Anaesth Intensive Care · Aug 2000
Randomized Controlled Trial Clinical TrialPostoperative sore throat and hoarseness following tracheal intubation using air or saline to inflate the cuff--a randomized controlled trial.
Sore throat and hoarseness following tracheal intubation is common. The aetiology may include high tracheal cuff pressures. We performed a double-blind, randomized controlled trial in 126 intubated patients to compare the incidence and severity of sore throat and hoarseness following inflation of the cuff using air or saline. ⋯ There was no statistically significant difference between the groups (air 15.9%, saline 14.5%). In the air group mean intra-cuff pressure increased significantly (start 14.0 mmHg, end 40.9 mmHg), while in the saline group there was no significant increase (start 12.7 mmHg, end 14.6 mmHg). The substitution of saline reliably results in sustained low intra-cuff pressures but high tracheal cuff pressure is not an important factor in the development of sore throat or hoarseness postoperatively within the pressure range and duration of operation studied.
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Anaesth Intensive Care · Aug 2000
Randomized Controlled Trial Clinical TrialPre-emptive analgesia with epidural morphine or morphine and bupivacaine.
Studies of preemptive analgesia in humans have shown conflicting results. The study design, patient population and the duration of assessment of postoperative pain are important in the evaluation of preemptive analgesia. We carried out a prospective, randomized, double-blind controlled study in 80 patients of physical status ASA 1-3 undergoing upper abdominal and thoracic surgery. ⋯ Pre MB compared to Pre M had significantly decreased total postoperative morphine requirements (P < 0.0001) and number of top-ups (P < 0.0001). Epidural morphine plus bupivacaine is effective as a preemptive analgesic. Morphine plus bupivacaine has better efficacy than morphine given alone before the induction of anaesthesia.
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Anaesth Intensive Care · Aug 2000
Randomized Controlled Trial Clinical TrialEffect of bolus dose of remifentanil on haemodynamic response to tracheal intubation.
A randomized placebo-controlled double-blinded study was conducted in 40 ASA 1 and 2 patients to determine the dose response of remifentanil in attenuating the haemodynamic response to tracheal intubation. Patients were allocated to one of four groups: placebo, remifentanil 1 microgram.kg-1, remifentanil 2 micrograms.kg-1 and remifentanil 4 micrograms.kg-1. A propofol target-controlled infusion was started at 4 micrograms.ml-1 and incrementally titrated to loss of verbal contact. ⋯ Systolic blood pressure following intubation increased by 30% in the placebo group, 10% in the 1 microgram.kg-1 group and remained unchanged in the 2 micrograms.kg-1 and 4 micrograms.kg-1 groups. Remifentanil 1 microgram.kg-1 attenuated the rise in heart rate and systolic blood pressure. Remifentanil 2 micrograms.kg-1 blocked the haemodynamic response completely: no further benefit was shown from increasing the dose to 4 micrograms.kg-1.
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Anaesth Intensive Care · Aug 2000
Randomized Controlled Trial Clinical TrialThe intubating laryngeal mask airway: effect of handle elevation on efficacy of seal, fibreoptic position, blind intubation and airway protection.
We conducted three studies to test the hypothesis that elevation of the intubating laryngeal mask (ILM) handle increases efficacy of seal, changes fibreoptic position, prevents aspiration of regurgitated fluid and improves intubation. In study 1, the ILM was inserted into 20 paralysed, anaesthetized patients and 20 cadavers. Oropharyngeal leak pressure and fibreoptic position were measured at an intracuff pressure of 0, 60 and 120 cm H2O with 0, 20 and 40 N of elevation force. ⋯ Aspiration and regurgitation usually occurred at the same oesophageal pressure. In study 3, blind intubation was more successful at 0 N than 40 N (15/20 v 8/20, P = 0.03). We conclude that elevation of the ILM handle has little clinical utility other than as a temporary measure to improve the efficacy of the seal.