Anaesthesia and intensive care
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Anaesth Intensive Care · May 1987
Randomized Controlled Trial Clinical TrialThe effects of formulation and addition of adrenaline to cocaine for haemostasis in intranasal surgery.
Twenty patients presenting for submucous resection of the nasal septum under general anaesthesia were randomly allocated to four groups to receive either 1.0 ml 25% cocaine HCl in paraffin paste, 1.0 ml 25% cocaine HCl combined with 0.1% adrenaline in paraffin paste, 4.0 ml aqueous 4% cocaine HCl combined with 0.05% adrenaline or 4.0 ml aqueous 4% cocaine HCl on ribbon gauze applied to the nasal mucosa. Mean intraoperative blood loss was significantly decreased when the 25% cocaine 0.1% adrenaline combination in paraffin paste was used (11 (SD 8) ml, 60 (SD 30) ml, P less than 0.05, for adrenaline and plain paste respectively). ⋯ Heart rate and blood pressure changes were similar in all four groups and cardiovascular toxicity was not observed. One ml of topical intranasal 25% cocaine HCl with 0.1% adrenaline in paraffin paste provided the best haemostasis for nasal septal surgery.
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Plasma osmolalities were measured in 100 normal, 100 general hospital and 100 intensive care patients, and compared with the osmolalities calculated from the plasma concentrations of sodium, potassium, glucose and urea, using five different published formulae. The mean osmolar gaps in the 100 consecutive intensive care patients and the 100 general hospital patients were not significantly different from the mean osmolar gap in the 100 normal individuals. The formula which gave the least difference between the measured and calculated osmolality was 2 X Na + urea + glucose, where the concentrations of sodium, urea and glucose were measured in mmol/l.
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Anaesth Intensive Care · May 1987
In-hospital cardiopulmonary resuscitation: prospective survey of management and outcome.
A sixteen-month prospective survey of in-hospital cardiac arrests indicated that of 168 patients who received cardiopulmonary resuscitation, 27 (16%) survived to leave hospital. Ninety-three per cent of these patients were ambulant and 81% were able to care for themselves. Poorest outcome was associated with initial rhythm of asystole, prolonged resuscitation and arrest in the Intensive Care Units. When compared with recent and past literature, these figures suggest that the incidence of successful outcome for cardiopulmonary resuscitation in hospitals has not changed significantly over the past twenty years.
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Small doses of epidural and intrathecal opioids produce effective and prolonged analgesia postoperatively, although the quality of analgesia does not differ from when conventional routes are used. The different opioids differ only in the speed of onset and duration of action, and in the incidence of side-effects. 'Minor' complications such as nausea, vomiting, pruritus and retention of urine are relatively common. ⋯ It is commoner after morphine and after intrathecal administration, and is also associated with advanced age, concomitant use of other central depressant drugs, respiratory disease and large doses. Because of the potentially lethal nature of this complication, it is recommended that the epidural and intrathecal routes of administration are used only when patients can be closely and constantly observed postoperatively.
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Relief of pain after surgery remains poor for the majority of patients. The pain is unpleasant, and is associated with arterial hypoxaemia, venous thrombosis, myocardial ischaemia and a more florid hormonal response to surgery. Regional analgesia, systemic, subarachnoid or extradural opioids and antiprostaglandin drugs are all used to treat pain after surgery. ⋯ Intravenous administration avoids both problems and excellent results have been obtained using Patient Controlled Analgesia devices, but these machines are expensive. A simple regimen suitable for application to large numbers of surgical patients is required. Continuous infusion of fentanyl 100 micrograms h-1 IV begun two hours before surgery and supplemented by a single bolus dose of fentanyl 100 micrograms IV provided an effective background of analgesia.