Anaesthesia and intensive care
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A previously healthy woman presented with chest pain and cervical swelling several hours after undergoing surgical removal of third molar teeth. Mediastinal and subcutaneous emphysema was demonstrated by chest X-ray. ⋯ Surgical handpieces that vent the air away from the surgical field should be used during such procedures. The mediastinal and subcutaneous air resolved after oxygen administration.
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Anaesth Intensive Care · Oct 2001
Randomized Controlled Trial Clinical TrialLaryngeal mask airway insertion in paediatric anaesthesia: comparison between the reverse and standard techniques.
Sixty-seven children between one and 15 years of age were randomized to have Laryngeal Mask Airway (LMA) insertion using either the standard technique (Group A) as described by Brain or the "reverse technique" (involving a 180 degree turn after insertion with the cuff facing the palate) (Group B). A blinded observer using a fibreoptic bronchoscope assessed the final position of the LMA. ⋯ The 95% confidence interval for the difference in success rates between Group B and A (B-A) was -0.73% to 20.1%. It is our opinion that the reverse technique of insertion of the LMA is an acceptable alternative to the standard technique.
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Anaesth Intensive Care · Oct 2001
Randomized Controlled Trial Clinical TrialHypotension in elderly patients undergoing spinal anaesthesia for repair of fractured neck of femur. A comparison of two different spinal solutions.
Intraoperative hypotension is a common and sometimes deleterious event in elderly patients undergoing spinal anaesthesia for repair of hip fractures. The synergism between intrathecal opioids and local anaesthetics may allow a reduction in the dose of local anaesthetic and reduce hypotension, while still maintaining adequate anaesthesia. We studied 42 elderly patients having insertion of a Richards pin and plate and compared 7.5 mg hyperbanic bupivacaine with added fentanyl 20 microg (group BF) to 12.5 mg hyperbaric bupivacaine alone (group B). ⋯ There was no difference in the incidence or severity of hypotension between the two groups. Two patients from group B and one from group BF experienced mild discomfort. Pruritus was more common in group BF.
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Anaesth Intensive Care · Oct 2001
Case ReportsA spoonful of sugar--improving the sensitivity of the glucose oxidase test strip method for detecting subclinical pulmonary aspiration of enteral feed.
A 74-year-old woman was admitted to the intensive care unit (ICU) with respiratory failure. Following intubation and mechanical ventilation, nasogastric enteral feeding was begun. The sensitivity of the glucose oxidase strip method for detecting aspiration of enteral feed has been questioned because the glucose levels in commonly used feeds are similar to those of normal tracheal aspirates. ⋯ Testing oral and tracheal secretions with standard glucose oxidase strips allowed the accurate detection of both pharyngeal regurgitation and tracheal aspiration. An episode of subclinical aspiration was detected and this was associated with a fall in the PaO2/FiO2 ratio. There were no further episodes of aspiration following the introduction of a gastric motility agent, maintaining the patient in the semi-recumbent position and an increase in the positive end expiratory pressure (PEEP).
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Anaesth Intensive Care · Oct 2001
Randomized Controlled Trial Clinical TrialChange in endotracheal tube cuff pressure during nitrous oxide anaesthesia: a comparison between air and distilled water cuff inflation.
In this prospective, randomized controlled trial, changes in endotracheal tube cuff pressure were studied in 60 patients undergoing elective surgery under general anaesthesia with nitrous oxide and oxygen. The cuffs were inflated with either air or distilled water. ⋯ The pressure and the rate of rise in cuff pressure were significantly lower (P<0.05) in the water-filled cuffs throughout the hour of study. When an endotracheal tube cuff is distended with water, the rise in cuff pressure during nitrous oxide anaesthesia is lower than that of an air-filled cuff.