Anaesthesia and intensive care
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Anaesth Intensive Care · Dec 2005
Randomized Controlled Trial Comparative StudyComparison of the re-usable LMA Classic and two single-use laryngeal masks (LMA Unique and SoftSeal) in airway management by novice personnel.
In a single-blind randomized trial, three types of laryngeal masks: the reusable LMA Classic, the single-use LMA Unique and SoftSeal were inserted by novice medical officers in anaesthesia. Five successive attempts were undertaken with each mask type. The order of the mask type insertion was randomly selected. ⋯ Novice medical doctors can be taught to insert disposable laryngeal masks. The SoftSeal took longer to insert, which resulted in a higher incidence of blood on the mask, but success rates did not differ The LMA Unique was associated with the lowest incidence of sore throat in the immediate postoperative period. A higher oropharyngeal leak pressure with the SoftSeal may indicate improved airway seal and protection against aspiration.
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Anaesth Intensive Care · Dec 2005
Randomized Controlled Trial Comparative StudyThe effect of supplemental oxygen on postoperative nausea and vomiting in children undergoing dental work.
Administration of 80% intraoperative oxygen has been proposed as being a cheap, safe and effective means of reducing postoperative nausea and vomiting (PONV) but no studies have been performed in the high risk paediatric population. We tested whether 80% intraoperative oxygen reduces PONV in well children undergoing elective day-stay dental treatment under general anaesthesia. ⋯ The total incidence of PONV was 40% in the group that received 30% oxygen and 33% in those that received 80% oxygen. High inspired intraoperative oxygen was not found to significantly reduce PONV in well children undergoing dental work under general anaesthesia.
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Anaesth Intensive Care · Dec 2005
Comparative StudyPrecise control of end-tidal carbon dioxide levels using sequential rebreathing circuits.
Anaesthesiologists have traditionally been consulted to help design breathing circuits to attain and maintain target end-tidal carbon dioxide (P(ET)CO2). The methodology has recently been simplified by breathing circuits that sequentially deliver fresh gas (not containing carbon dioxide (CO2)) and reserve gas (containing CO2). Our aim was to determine the roles of fresh gas flow, reserve gas PCO2 and minute ventilation in the determination of P(ET)CO2. ⋯ The optimal settings to maintain P(ET)CO2 independently of minute ventilation are 1) fresh gas flow equal to minute ventilation minus anatomical deadspace ventilation, and 2) reserve gas PCO2 equal to alveolar PCO2. We provide an equation to assist in identifying gas settings to attain a target PCO2. The ability to precisely attain and maintain a target PCO2 (isocapnia) using a sequential gas delivery circuit has multiple therapeutic and scientific applications.
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Anaesth Intensive Care · Dec 2005
Case ReportsArterial oxygen desaturation during only one of two similar thoracoscopic procedures on the same patient.
The present report describes two similar thoracoscopic procedures performed on the same 81-year-old male patient. Because acute hypoxia had developed during one-lung ventilation on the first occasion, serial blood gases were taken during the second. Also, whereas on the first occasion the non-ventilated lung had been left open to air when one-lung ventilation was initiated, on the second it was connected to an ambient pressure oxygen source with the object of theoretically enabling apnoeic oxygenation during lung collapse. It is argued that this fundamental difference in anaesthetic practice may have contributed to the improved oxygenation that was recorded during the second thoracoscopy.
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Anaesth Intensive Care · Dec 2005
Comparative StudyThe influence of the current medicolegal climate on New South Wales anaesthetic practice.
A survey was posted to all New South Wales and Provisional Fellows of the Australian and New Zealand College of Anaesthetists to assess the influence of the current medicolegal climate on their anaesthetic practice. Information collected included demographics, opinions regarding the current medico-legal climate, medical defence organizations, and the implications for anaesthetic practice. The response rate was 78% (640/820). ⋯ Changes to the conduct of the preoperative consultation were common. Other changes to practice included more thorough documentation of complications (50.8%) and a strong reluctance to perform neuraxial blocks (54%). This survey suggests that anaesthetists are concerned about the current medicolegal climate and as a result, some are retiring earlier and giving up high-risk areas of practice.