Anaesthesia and intensive care
-
Anaesth Intensive Care · Feb 1992
Randomized Controlled Trial Comparative Study Clinical TrialComparison of epidural and intravenous opioid analgesia after elective caesarean section.
Patient acceptance is a particularly relevant method of assessing currently employed epidural and intravenous techniques of opioid analgesia after elective caesarean section. We have prospectively studied 71 such patients, randomised postoperatively to receive epidural morphine, intravenous morphine or intravenous pethidine. When compared with either intravenous opioid, epidural morphine provided twofold better average or excellent analgesia with 30% less drowsiness but with about 50% more pruritus. In spite of this troublesome complication, more patients (83% vs 74%) preferred epidural to intravenous opioid analgesia.
-
Anaesth Intensive Care · Aug 1991
Randomized Controlled Trial Comparative Study Clinical TrialThickly and thinly applied lignocaine-prilocaine cream prior to venepuncture in children.
EMLA cream (Astra Pharmaceuticals) which contains lignocaine and prilocaine, is widely used in a thick layer to reduce the pain associated with venepuncture. Application of smaller amounts of cream lowers cost and may reduce side-effects. The efficacy of a thick layer (using 2.0 ml) and a thin layer (using 0.5 ml) of lignocaine-prilocaine cream prior to venepuncture was compared in a randomised study of one hundred children. ⋯ Children in the thin layer study group experienced slight pain more often than children in the thick layer study group (P less than 0.01). No child in either group experienced moderate or severe pain. It is concluded that a thin layer of lignocaine-prilocaine cream is not as effective as a thick layer in producing the pain-free venepuncture which is desirable in children.
-
Anaesth Intensive Care · Aug 1991
Randomized Controlled Trial Clinical TrialDoes combined epidural lignocaine and fentanyl provide better anaesthesia for ESWL than lignocaine alone?
The efficacy of epidural fentanyl combined with lignocaine 1.5% with adrenaline 1:200,000 was studied in a randomised, double-blind, controlled trial of two hundred patients undergoing extracorporeal shock wave lithotripsy with or without ancillary procedures. The quality of anaesthesia was assessed using linear analogue pain scores, the patient's impression, and the rate of intra-operative intervention by the anaesthetist. ⋯ The only significant difference lay postoperatively in that the fentanyl-ancillary procedure sub-group had less pain approximately one hour postoperatively (P = 0.01). In the context of this study and in the presence of an adequate autonomic and somatic local anaesthetic blockade, the addition of epidural fentanyl does not appear to confer any significant advantage other than to enhance postoperative analgesia.
-
Anaesth Intensive Care · May 1991
Randomized Controlled Trial Comparative Study Clinical TrialA comparison of two-lung high frequency positive pressure ventilation and one-lung ventilation plus 5 cm H2O non-ventilated lung CPAP, in patients undergoing anaesthesia for oesophagectomy.
A randomised prospective controlled study was conducted during a one-year period on patients scheduled for oesophagectomy via a right thoracotomy approach. Twenty-two patients received one-lung ventilation (OLV group) and twenty patients received high frequency positive pressure ventilation (HFPPV group). ⋯ The mean peak inspiratory pressure and average mean airway pressure were significantly lower in the HFPPV group 28.8 (SD 7.7) and 7.2 (SD 2.4) cm H2O respectively, compared with the OLV group, 40.0 (SD 9.9) and 11.9 (SD 4.9) cm H2O (P less than 0.05). Two-lung high frequency positive pressure ventilation has some advantages over one-lung ventilation during the thoracotomy phase of oesophagectomy because it is easy to administer, does not significantly compromise the surgical exposure and is associated with fewer severe undesirable physiological disturbances.
-
Anaesth Intensive Care · May 1991
Randomized Controlled Trial Comparative Study Clinical TrialArterial desaturation during induction in healthy adults: should preoxygenation be a routine?
We studied the haemoglobin saturation of one hundred healthy patients equally divided into two groups. Group 1 patients received three minutes of preoxygenation prior to thiopentone induction followed by inhalational anaesthetics. ⋯ None of the patients in Group 1 showed any arterial oxygen desaturation during the five minutes of the induction period, whereas 21 patients in Group 2 showed definite desaturation (P less than 0.005), of which fifteen patients had a saturation of 90% or less (P less than 0.005) and six had a saturation of 85% or less. Since those were healthy patients and the anaesthetics were given by experienced anaesthetists, we concluded that some form of preoxygenation should be used in all patients receiving general anaesthesia.