Anaesthesia and intensive care
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Anaesth Intensive Care · Feb 2006
Randomized Controlled Trial Comparative StudyEffectiveness of 3-in-1 continuous femoral block of differing concentrations compared to patient controlled intravenous morphine for post total knee arthroplasty analgesia and knee rehabilitation.
We assessed the effectiveness of the 3-in-1 continuous femoral block as a form of postoperative pain relief for unilateral total knee arthroplasty (TKA). Sixty patients undergoing elective unilateral TKA under subarachnoid block were randomized into three groups. Postoperative analgesia was provided with a continuous 3-in-1 femoral nerve catheter with 0.15% ropivacaine in group A, a continuous 3-in-1 femoral nerve catheter with 0.2% ropivacaine in group B, or patient controlled intravenous morphine in group C (control group). ⋯ There was no statistical difference between the groups when comparing the day of first ambulation and the time to discharge from the hospital. Satisfaction scores were higher in group A (P = 0.028) and group B (P = 0.002) compared to group C. We conclude that a continuous 3-in-1 femoral nerve block with ropivacaine 0.15% or 0.2% for elective unilateral TKA has an opioid-sparing effect.
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Anaesth Intensive Care · Feb 2006
Randomized Controlled Trial Comparative StudyProspective randomized comparison of progressive dilational vs forceps dilational percutaneous tracheostomy.
This trial prospectively compares two methods of percutaneous tracheostomy, both routinely used in ICU: the Ciaglia progressive dilational tracheostomy and the Griggs forceps dilational tracheostomy. One hundred patients were randomized using a single-blinded envelope method to receive progressive or forceps percutaneous tracheostomy performed at the bedside. Operative time, the occurrence of hypoxaemia or hypercapnia and complications were recorded. ⋯ Minor complications (minor bleeding, transient hypoxaemia, damage to posterior tracheal wall without emphysema) were also more frequent with the progressive technique (31 vs. 9 complications, P < 0.0001). Six major complications occurred with the progressive technique, none with the forceps technique (P = 0.0085): tension pneumothorax, posterior tracheal wall injury with subcutaneous emphysema, loss of airway with hypoxaemia, loss of stoma with impossible re-catheterization, and two conversions to another technique. In conclusion, progressive dilational tracheostomy took longer, caused more hypercapnia and more minor and major difficulties than forceps dilational tracheostomy.
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Anaesth Intensive Care · Feb 2006
Randomized Controlled TrialEffect of tramadol on Bispectral Index during intravenous anaesthesia with propofol and remifentanil.
The aim of this study was to investigate the effects of tramadol on the Bispectral Index (BIS) during total intravenous propofol-remifentanil anaesthesia. Forty-four adult ASA Physical status I-II patients, scheduled for elective general surgical procedures were included in a prospective observational randomized study. Doses for anaesthetics and opioids were adjusted to keep the BIS value at 50 +/- 5. ⋯ There were no significant changes in mean arterial pressure, SpO2, or heart rate (P > 0.05). The results indicate that the administration of tramadol during stable total intravenous anaesthesia with propofol-remifentanil does not affect BIS values. The clinical relevance is that tramadol can be safely administered pre- and intraoperatively as pre-emptive or preventive analgesia without modification of the depth of anaesthesia.
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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.