Anaesthesia and intensive care
-
Anaesth Intensive Care · Aug 2003
Randomized Controlled Trial Clinical TrialCryoprecipitate for the correction of coagulopathy associated with liver disease.
In patients with liver disease at risk of pulmonary oedema, cryoprecipitate (small volume) might be a viable alternative to fresh frozen plasma (FFP, large volume) in the correction of coagulopathy. However, the efficacy of cryoprecipitate in these patients has not been tested. We evaluated the role of cryoprecipitate in the correction of the coagulopathy of liver disease. ⋯ Cryoprecipitate improves the coagulopathy of liver disease. Four units of FFP are more efficacious than five units of cryoprecipitate. Cryoprecipitate may have a role in correction of the coagulopathy associated with liver disease where concerns about pulmonary oedema exist.
-
Cricoid pressure has been used for over 200 years. During that time, training in the technique has not changed greatly, despite the well-documented potential for complications if performed improperly. Typically, training relies on quantitative or qualitative descriptions such as "firm" pressure, a number of Newtons of force or equivalent force to that causing pain while pressing on the nose. ⋯ One subject maintained pressure in the range of 25 to 35 Newtons for the entire 45 seconds of the first attempt but no subject performed this well on the second attempt. The use of qualitative and quantitative descriptors of the appropriate pressure does not appear useful in the training of the technique of cricoid pressure. Training incorporating force feedback is recommended.
-
Anaesth Intensive Care · Aug 2003
Patient-controlled epidural analgesia: a prospective audit of epidural pethidine 4 mg/ml and ropivacaine 0.2% with fentanyl 2 micrograms/ml.
A prospective audit of one hundred and forty-seven (147) Acute Pain Service (APS) patients, who received postoperative patient-controlled epidural analgesia (PCEA) using pethidine 4 mg/ml or ropivacaine 0.2% with fentanyl 2 micrograms/ml in general surgical or orthopaedic wards over a twelve-month period, is presented. Data were collected from APS observation charts over a 48-hour period postoperatively. We found no significant difference in postoperative analgesia or side-effects between pethidine and ropivacaine with fentanyl in orthopaedic or general surgical patients.
-
A case of acute thyroid swelling is reported following intubation of a young woman with a pre-existing small goitre. The thyroid enlargement then distorted the airway, necessitating an emergency thyroidectomy. The application of cricoid pressure was believed to have caused the intrathyroidal bleeding and the complications of cricoid pressure are reviewed.
-
Anaesth Intensive Care · Aug 2003
Clinical Trial Controlled Clinical TrialSimulated epidural test doses using adrenaline and adrenaline/clonidine in sevoflurane-anaesthetized children.
A pilot study was conducted using a simulated epidural test dose to ascertain the effects adrenaline, adrenaline/clonidine mixture, and clonidine alone on the accepted criteria for determining the occurrence of an epidural intravascular injection. Seventy-five ASA 1 or 2 children aged from six months to twelve years were sequentially allocated to one of three groups: group A: adrenaline 0.5 microgram/kg, group AC: adrenaline 0.5 microgram/kg and clonidine 0.3 microgram/kg, and group C: clonidine 0.3 microgram/kg. Effects on heart rate, T-wave amplitude and systolic blood pressure were determined after induction of anaesthesia and stabilization using sevoflurane in nitrous oxide and oxygen. ⋯ There were no significant differences between groups A and AC for any parameter. Negative predictive value estimates for the current criteria for intravascular injection were low. Clonidine 0.3 microgram/kg produced no effects on the study variables.