The Journal of international medical research
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Randomized Controlled Trial
Pre-measured length using landmarks on posteroanterior chest radiographs for placement of the tip of a central venous catheter in the superior vena cava.
Central venous catheterization (CVC) is a common procedure but catheter misplacement is a frequent complication and can be lethal. Most CVCs are inserted at a recommended mean depth of 15 cm from the skin puncture site. Chest radiographs are used to confirm the positioning of CVCs, with the carina regarded as a reliable landmark for tip placement. ⋯ To test the accuracy of C-length based CVC placement, 637 adult patients scheduled to undergo elective major abdominal procedures and neurological surgical procedures requiring CVC were randomized to undergo either the 15-cm guided method or the C-length guided method for placement of the CVC tip into the superior vena cava (SVC). All the CVC tips in the C-length group were successfully placed in the SVC. These findings indicate that the pre-measured C-length using two landmarks can be used to determine the insertion length and to place the CVC tip successfully into the SVC.
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Randomized Controlled Trial Comparative Study
A comparison of consumption and recovery profiles according to anaesthetic circuit mode using a new multifunctional closed-circuit anaesthesia system during desflurane anaesthesia: a clinical study.
This clinical study compared induction time, consumed anaesthetic dose, and haemodynamic and recovery profiles when using a new type of multifunctional anaesthesia machine (Zeus) in semi-closed or closed circuit modes. Sixty female patients undergoing gynaecological surgery were randomly assigned to three groups and received desflurane anaesthesia through a semi-closed circuit (SCC) at fresh gas flow rates of 4 l/min (SCC 4 l/min) or 2 l/min (SCC 2 l/min), or through a closed circuit (CC). ⋯ There were no differences in haemodynamic and recovery profiles between the groups. It is concluded that the CC mode allowed a faster and more reliable induction, lower anaesthetic consumption and stable haemodynamic and recovery profiles.
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Randomized Controlled Trial
Phenylephrine attenuates intra-operative hypothermia during spinal anaesthesia.
Inadvertent hypothermia is common during spinal anaesthesia. This study was based on the hypothesis that phenylephrine might attenuate core hypothermia by inhibiting core-to-peripheral redistribution of body heat during spinal anaesthesia. In this prospective randomized study, 20 patients who underwent elective orthopaedic surgery under spinal anaesthesia were randomly assigned to receive either normal saline (control group) or continuously-infused phenylephrine 0.5 microg/kg per min (phenylephrine group). ⋯ Mean +/- SE core temperature at the end of surgery was significantly higher in the phenylephrine-treated group compared with the control group (35.9 +/- 0.1 degrees C versus 35.0 +/- 0.1 degrees C, respectively), although there was no significant difference in baseline core temperature (both groups 36.3 +/- 0.1 degrees C). Mean HR and MAP were not significantly different between the two groups. In conclusion, continuously-infused phenylephrine attenuated core hypothermia during spinal anaesthesia without any haemodynamic complications.
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Randomized Controlled Trial
Efficacy and safety of an intra-operative intra-articular magnesium/ropivacaine injection for pain control following total knee arthroplasty.
Eighty patients with osteoarthritis who underwent unilateral total knee arthroplasty were randomly assigned to two groups: the trial group received an intra-operative intra-articular injection of magnesium sulphate and ropivacaine, and the control group received an injection of normal saline. All patients received patient-controlled analgesia with morphine for 48 h post-operatively. ⋯ The time to be able to perform a straight leg raise and to reach a 90 degrees knee flexion was significantly shorter in the trial group compared with the controls. This study demonstrated that an intra-operative intra-articular magnesium sulphate and ropivacaine injection reduced the use of post-operative morphine.
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Randomized Controlled Trial Comparative Study
Comparison of stress hormone response, interleukin-6 and anaesthetic characteristics of two anaesthetic techniques: volatile induction and maintenance of anaesthesia using sevoflurane versus total intravenous anaesthesia using propofol and remifentanil.
This prospective randomized study compared the effects of two types of anaesthesia on peri-operative anaesthetic profiles from induction to recovery and on immunological and neurohormonal responses to anaesthesia and surgical stress. Forty patients were assigned to undergo either volatile induction and maintenance of anaesthesia (VIMA) with sevoflurane or total intravenous anaesthesia (TIVA) with propofol and remifentanil. ⋯ Adrenaline, noradrenaline, cortisol and glucose levels were significantly lower with TIVA than VIMA, but there was no difference in IL-6 levels between the two groups. TIVA with propofol and remifentanil may be preferable to VIMA with sevoflurane alone because it leads to smoother, more rapid induction, more rapid awakening and lower stress responses to surgical stimuli.