Anaesthesia and intensive care
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Anaesth Intensive Care · Aug 2007
Randomized Controlled Trial Comparative StudyComparative safety and efficacy of two high dose regimens of oral paracetamol in healthy adults undergoing third molar surgery under local anaesthesia.
This study compared the efficacy and safety of single oral doses of 60 mg/kg and 90 mg/kg paracetamol in fit young adult patients undergoing third molar extractions. The study was a randomised, blinded, crossover design on 20 young, fit adults. ⋯ There was a reduction in factor VII activity with 90 mg/kg dose compared to 60 mg/kg dose. It may be concluded that the 90 mg/kg dose, though safe, does not offer any advantages over 60 mg/kg dose of paracetamol in young fit adults undergoing third molar surgery.
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Anaesth Intensive Care · Jun 2007
Randomized Controlled TrialImpact of bispectral index monitoring on propofol administration in patients undergoing cardiopulmonary bypass.
Propofol anaesthesia using target control infusion during cardiac surgery has become more popular recently. However, without depth of anaesthesia monitoring, the standard target concentration used may be higher than necessary to maintain adequate hypnosis during hypothermic cardiopulmonary bypass. The purpose of this study was to evaluate the effect of bispectral index monitoring on propofol administration during hypothermic cardiopulmonary bypass. ⋯ The bispectral index value during bypass was significantly lower in group C than in group B, reflecting a deeper state of anaesthesia. There was no difference in the use of inotropes, vasoconstrictors or vasodilators. Bispectral index monitoring enables a 50% reduction in propofol administration at this standard dose during hypothermic cardiopulmonary bypass.
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Anaesth Intensive Care · Jun 2007
Randomized Controlled TrialBispectral index as a predictor of sedation depth during isoflurane or midazolam sedation in ICU patients.
Bispectral index (BIS) is used for monitoring anaesthetic depth with inhaled anaesthetic agents in the operating room but has not been evaluated as a monitor of sedation depth in the intensive care unit (ICU) setting with these agents. If BIS could predict sedation depth in ICU patients, patient disturbances could be reduced and oversedation avoided. Twenty ventilator-dependent ICU patients aged 27 to 80 years were randomised to sedation with isoflurane via the AnaConDa or intravenous midazolam. ⋯ In conclusion, BIS XP does not reliably predict sedation depth as measured by clinical evaluation in non-paralysed ICU patients sedated with isoflurane or midazolam. EMG contributes significantly to BIS values in isoflurane or midazolam sedated, non-paralysed ICU patients. End-tidal isoflurane concentration appeared to be a better indicator of clinical sedation depth than BIS.
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Anaesth Intensive Care · Jun 2007
Randomized Controlled TrialClosed-loop anaesthesia delivery system (CLADS) using bispectral index: a performance assessment study.
The development of electroencephalographic indices of anaesthetic depth has in turn generated interest in automated anaesthesia delivery systems using these as the input variable. In this paper, one patented closed loop anaesthesia delivery system (CLADS) (502/DEL/2003) is compared to manual control of propofol delivery titrated to the bispectral index (BIS). Forty ASA I-II patients undergoing elective surgery under general anaesthesia were enrolled in the study. ⋯ Smaller amounts of anaesthetic agent were required (P < 0.01) and there was faster postoperative recovery (P < 0.05). Manual delivery of propofol required the infusion rate to be changed a median of 30 times (IQR 12-45), which required considerable time and attention by the anaesthetist. In conclusion, automated delivery of propofol adjusted to the bispectral index using our CLADS was both effective and efficient as compared to manual control.
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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.