Anaesthesia and intensive care
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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.
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Anaesth Intensive Care · Feb 2007
Randomized Controlled Trial Comparative StudyComparison of the AMBU Laryngeal Mask and the LMA Classic in anaesthetised, spontaneously breathing patients.
There may be a role for single-use laryngeal mask airways with concerns about inability to adequately sterilise laryngeal mask airways to eradicate prion proteins. A single-blinded prospective randomised controlled trial was conducted to compare the clinical performance of the single-use AMBU LMA with the reuseable LMA Classic. ⋯ There was a suggestion of reduced postoperative sore throat and pharyngeal trauma for the AMBU LMA group. The AMBU LMA is a viable alternative to the LMA Classic for airway management in spontaneously breathing patients.
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Anaesth Intensive Care · Feb 2007
Randomized Controlled Trial Comparative StudyRemifentanil vs. lignocaine for attenuating the haemodynamic response during rapid sequence induction using propofol: double-blind randomised clinical trial.
This study was conducted to determine whether lignocaine or remifentanil effectively attenuate the response to endotracheal intubation during rapid sequence induction. Forty-eight patients were randomly divided into three groups: Group NS (n = 16) received normal saline 0.1 ml/kg, Group L (n = 16) received lignocaine 1.5 mg/kg, and Group R (n = 16) received remifentanil 1 microg/kg. Anaesthesia was induced with propofol 2 mg/kg after glycopyrrolate 0.2 mg IV. ⋯ The maximum increase in mean arterial pressure in Group NS and Group L were 46% and 38% respectively above the baseline value one minute after intubation, whereas the mean arterial pressure in Group R increased only back to the baseline value. Heart rate in Group NS and Group L were increased by 27% and 33% above baseline value respectively one minute after intubation, while that in Group R was increased only to the baseline value. The results indicate that remifentanil 1 microg/kg, but not lignocaine 1.5 mg/kg, effectively attenuates the haemodynamic response to endotracheal intubation during rapid sequence induction using propofol.
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Anaesth Intensive Care · Feb 2007
Randomized Controlled TrialThe ProSeal laryngeal mask airway is an effective alternative to laryngoscope-guided tracheal intubation for gynaecological laparoscopy.
We tested the hypothesis that the ProSeal laryngeal mask airway is superior to laryngoscope-guided tracheal intubation for gynaecological laparoscopy. One-hundred and eighty consecutive patients (ASA grade 1-2, aged 18-80 y) were divided into two equal-sized groups for airway management with the ProSeal laryngeal mask airway or tracheal tube. Induction was with fentanyl/propofol, maintenance with sevoflurane and muscle relaxation with atracurium. ⋯ The duration of surgery, duration of pneumoperitoneum and intra-abdominal pressures were similar Gastric size was similar at the start and end of surgery. There were no differences in the frequency of complications or sore throat. We conclude that the ProSeal laryngeal mask airway is a similarly effective airway device to conventional laryngoscope-guided tracheal intubation for gynaecological laparoscopy, but is more rapidly inserted and associated with an attenuated haemodynamic response to insertion and removal.