Anaesthesia and intensive care
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Anaesth Intensive Care · Feb 1989
Randomized Controlled Trial Comparative Study Clinical TrialCardiovascular responses to tracheal intubation: a comparison of direct laryngoscopy and fibreoptic intubation.
The cardiovascular responses to tracheal intubation using a fibreoptic bronchoscope or Macintosh laryngoscope were compared in twenty in-patients and twenty day-stay patients. Within these groups patients were randomly allocated to direct laryngoscopic or fibreoptic bronchoscopic intubation. Arterial blood pressure, heart rate and arterial oxygen saturation were recorded before induction and at one-minute intervals until four minutes after intubation. ⋯ In the in-patients mean heart rate was significantly higher in those patients intubated with the bronchoscope at three and four minutes after intubation. Time taken for intubation was significantly longer in those patients intubated with the bronchoscope. In no patient did the arterial oxygen saturation fall below 98%.
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Anaesth Intensive Care · May 1988
Randomized Controlled Trial Clinical TrialFentanyl pretreatment modifies anaesthetic induction with etomidate.
Haemodynamic changes and side-effects of induction of anaesthesia with etomidate were evaluated in 60 ASA Class I or II patients. The objective was to find an optimal pre-induction dose of fentanyl which eliminated haemodynamic changes and side-effects during induction and intubation without introducing other problems. Patients were randomly assigned to four groups according to the pretreatment dose of fentanyl (Group I = 2 ml normal saline; Group II = 100 micrograms of fentanyl; Group III = 250 micrograms of fentanyl; Group IV = 500 micrograms of fentanyl) administered intravenously five minutes prior to induction of anaesthesia with etomidate, 0.3 mg/kg. ⋯ There were also significant linear regression relationships (P less than 0.01 ANOVA for linear regression) between increasing doses of fentanyl administered before etomidate and the prevention of increases in systolic blood pressure and heart rate during the induction-intubation sequence. The data demonstrate that increasing pre-induction doses of fentanyl are more effective at minimising side-effects and preventing increases in systolic arterial blood pressure and heart rate but also increase the incidence of apnoea during induction. The results suggest that 500 micrograms of fentanyl is an ideal pretreatment dose in fit patients prior to anaesthetic induction with etomidate.
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Anaesth Intensive Care · May 1988
Randomized Controlled Trial Comparative Study Clinical TrialEpidural anaesthesia for caesarean section: a comparison of 0.5% bupivacaine and 2% lignocaine both with adrenaline.
Thirty-eight women having caesarean section under epidural anaesthesia received either lignocaine 2% or bupivacaine 0.5% both with adrenaline 1:200,000 in a double-blind, randomised study. The time to establish satisfactory surgical anaesthesia, the volume required and the quality of analgesia as assessed by the anaesthetist, patient pain and discomfort scales and patient approval, were not significantly different. ⋯ Neonatal outcomes were uniformly good. Both local anaesthetics provided satisfactory epidural anaesthesia and neither proved to have a distinct advantage in the clinical setting of this study.
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Anaesth Intensive Care · May 1988
Randomized Controlled Trial Clinical TrialThe prevention of gastric inflation--a neglected benefit of cricoid pressure.
The ability of cricoid pressure to prevent inflation of the stomach during mask ventilation of a patient was studied. Fifty patients were randomly allocated to either have or not have cricoid pressure applied during a three-minute period of standardised mask ventilation. ⋯ However, in a subgroup of patients considered difficult to ventilate, cricoid pressure seemed less successful in preventing gastric inflation. Cricoid pressure is a useful technique for reducing gastric inflation during mask ventilation, particularly in patients who are relatively easy to ventilate.
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Anaesth Intensive Care · Aug 1987
Randomized Controlled Trial Comparative Study Clinical TrialA clinical comparison of atracurium and vecuronium in women undergoing laparoscopy.
In a double-blind, prospective, randomised trial in 30 women undergoing laparoscopy, atracurium and vecuronium were compared in equipotent (2 X ED95) doses. In the atracurium group, first twitch depression was significantly greater at one minute, and degree of fade significantly greater at one and two minutes, but thereafter neuromuscular monitoring showed no significant difference between the groups. Clinically there was no significant difference between the drugs. ⋯ Reversal and recovery were comparable in the two groups. Neostigmine was required in all patients and in three (one atracurium, two vecuronium) a second dose was required in all patients and in three (one atracurium, two vecuronium) a second dose was administered on clinical grounds. Antagonism of the neuromuscular block is required with surgery of this duration despite the intermediate duration of action of the relaxant drugs.