Anaesthesia and intensive care
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Anaesth Intensive Care · Apr 2007
Randomized Controlled TrialThe impact of bispectral index monitoring on sedation administration in mechanically ventilated patients.
The aim of this prospective randomised controlled trial was to assess the effectiveness of the Bispectral Index (BIS) monitor in supporting clinical sedation management decisions in mechanically ventilated intensive care unit patients. Fifty adult mechanically ventilated surgical and general intensive care unit patients receiving sedative infusions of morphine and midazolam were randomly allocated to receive BIS monitoring (n=25) or standard sedation management (n=25). In the BIS group, sedation was titrated to maintain a BIS value of greater than 70. ⋯ The same inverse relationship existed for both sedative agents (morphine P = 0.005, midazolam P = 0.03). Duration of mechanical ventilation was comparable in the two groups. We conclude that the use of BIS monitoring did not reduce the amount of sedation used, the length of mechanical ventilation time or the length of ICU stay.
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Anaesth Intensive Care · Apr 2007
Randomized Controlled Trial Comparative StudyPerformance comparison of two anaesthetic facemasks.
When considering anaesthetic masks, the quality of the mask-face seal is a key determinant of performance. This randomised crossover trial utilises expired oxygen concentration to compare the efficacy of two routinely used facemasks. Thirty subjects were randomised to breathe 100% oxygen via either a traditional reusable black rubber mask or the disposable Intersurgical Scented mask for three minutes. ⋯ From the oxygen wash-in curves, the Intersurgical mask consistently outperformed the black rubber mask. At three minutes the Intersurgical mask performed better than the black rubber mask, with mean end-tidal oxygen concentrations of 86.9% vs. 81% respectively; P=0.008. These findings indicate that the soft cuff design of the intersurgical mask provided a better seal than the black rubber facemask.
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Anaesth Intensive Care · Apr 2007
Randomized Controlled TrialThe use of ketamine as rescue analgesia in the recovery room following morphine administration--a double-blind randomised controlled trial in postoperative patients.
In some patients, control of postoperative pain can be difficult with morphine alone. This double-blind randomised controlled trial was designed to evaluate whether a small bolus dose of ketamine could improve pain scores in those patients who had inadequate relief of their postoperative pain after two standard doses of morphine. Forty-one patients with uncontrolled postoperative pain were randomly assigned to receive either morphine (M) alone, or morphine plus 0.25 mg/kg ketamine (K) in the recovery room. ⋯ There was no statistically significant difference in verbal rating scale pain scores between the two groups either in the recovery room (K = 5.16, M = 6.28, P = 0.065), or at a later time on the ward. There was no apparent difference between groups in sedation, morphine consumption, postoperative nausea and vomiting, quality of recovery or need for rescue analgesia. We could not demonstrate an effective role for ketamine in the management of problematic postoperative pain at the dose studied.