Anaesthesia and intensive care
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Anaesth Intensive Care · Jan 2013
Randomized Controlled Trial Comparative StudyA prospective randomised comparison of the LMA ProSeal™ versus endotracheal tube on the severity of postoperative pain following gynaecological laparoscopy.
Use of the LMA ProSeal when compared with intubation for gynae-laparoscopy does not decrease post-operative pain or PONV.
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Anaesth Intensive Care · Jan 2013
Randomized Controlled TrialEpidural anaesthesia with goal-directed administration of ropivacaine improves haemodynamic stability when combined with general anaesthesia in elderly patients undergoing major abdominal surgery.
The use of epidural ropivacaine may result in significant haemodynamic fluctuations during combined epidural and general anaesthesia. We designed this study to investigate whether epidural anaesthesia with a goal-directed approach, when combined with general anaesthesia, improved haemodynamic stability in elderly patients undergoing major abdominal surgery. Seventy-five elderly patients undergoing major abdominal surgery were randomly and evenly assigned to one of three groups receiving intraoperative epidural anaesthesia with either ropivacaine 0.1% (Group 1), ropivacaine 0.375% (Group 2) or ropivacaine 0.375% for abdominal wall pain and ropivacaine 0.1% for visceral pain (Group 3). ⋯ The need for vasoactive drug administrations was 1.4 (standard deviation 0.9) in Group 3 (n=24), representing a significantly lower frequency of administration compared with Groups 1 (n=24) and 2 (n=24) (P <0.05 versus Group 1; P <0.01 versus Group 2). The total intraoperative dose of remifentanil was significantly greater in Group 1 (P <0.01 versus Group 2; P <0.05 versus Group 3) but did not differ significantly between Groups 2 and 3. Goal-directed epidural anaesthesia with different ropivacaine concentrations can improve haemodynamic stability when combined with general anaesthesia for elderly patients undergoing major abdominal surgery.
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Anaesth Intensive Care · Jan 2013
Comparative StudyFinancial and environmental costs of manual versus automated control of end-tidal gas concentrations.
Emerging technologies that reduce the economic and environmental costs of anaesthesia have had limited assessment. We hypothesised that automated control of end-tidal gases, a new feature in anaesthesia machines, will consistently reduce volatile agent consumption cost and greenhouse gas emissions. As part of the planned replacement of anaesthesia machines in a tertiary hospital, we performed a prospective before and after study comparing the cost and greenhouse gas emissions of isoflurane, sevoflurane and desflurane when using manual versus automated control of end-tidal gases. ⋯ Automated control reduced costs by 27%. Greenhouse gas emissions decreased by 44%, a greater than expected decrease facilitated by a proportional reduction in desflurane use. Automated control of end-tidal gases increases participation in low flow anaesthesia with economic and environmental benefits.
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Anaesth Intensive Care · Jan 2013
ReviewBreastfeeding after anaesthesia: a review of the pharmacological impact on children.
Post-anaesthetic advice imparted to breastfeeding mothers can vary. This is due in part to the differing information from published data, product information sheets and inevitably from the unhindered flow of opinions available on the internet. This literature review examined the evidence relating to drugs commonly used in the modern anaesthetic setting and their impact on breastfed children. It suggests that special precautions are rarely warranted in the post-anaesthetic care of breastfeeding patients.
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Anaesth Intensive Care · Jan 2013
Case ReportsEarly tracheal stenosis causing extubation failure and prolonged ventilator dependency.
Postintubation stenosis is the most frequent cause of benign tracheal stenosis and may cause reintubation and delay in weaning of intensive care unit patients. This case study describes typical patients with tracheal stenosis and the management of these patients. Five patients requiring reintubation and mechanical ventilation due to early intubation-related stenosis are discussed. ⋯ Tracheal stenosis developing in the subglottic region after extubation, especially after exposure to cuff pressure, may lead to reintubation. A tracheostomy may hinder the diagnosis of progressive stenosis and may lead to unnecessary maintenance of ventilator treatment. Early intubation-related tracheal stenosis should therefore be considered in cases of weaning or extubation failure and prompt appropriate investigation and treatment.