Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Randomized Controlled Trial Comparative Study Clinical Trial
Ketorolac and indomethacin are equally efficacious for the relief of minor postoperative pain.
Injectable ketorolac is an effective analgesic in ambulatory surgery patients. However, no studies have compared ketorolac with other NSAIDs in this setting. The analgesic efficacy of intramuscular ketorolac, rectal indomethacin and placebo was compared in healthy women undergoing gynaecological or breast surgery as outpatients. ⋯ However, no differences were observed between the two NSAIDS. Side effects were similar in all groups. We conclude that im ketorolac and pr indomethacin are equally effective analgesics in this group of patients.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of the 25-gauge Whitacre with the 24-gauge Sprotte spinal needle for elective caesarean section: cost implications.
Spinal anaesthesia provides rapid, safe anaesthesia for Caesarean section. The pencil-point spinal needles (Sprotte and Whitacre) are reported to have a low incidence of post-dural puncture headache (PDPH). As the 25G Whitacre is less expensive than the 24G Sprotte needle, this prospective, randomized, double-blind study was designed to compare the incidence of PDPH and ease of insertion of these needles in 304 ASA 1 and 2 women having elective Caesarean section under spinal anaesthesia. ⋯ There was no correlation between the occurrence of PDPH and the difficulty of needle insertion, presence of transient hypotension or the effectiveness of anaesthesia delivered. This study indicates that both needles are comparable with respect to ease of insertion and incidence of PDPH. As the Whitacre needle is less expensive it is a reasonable alternative to the more expensive Sprotte needle.
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Randomized Controlled Trial Comparative Study Clinical Trial
Anaesthesia for adenotonsillectomy: a comparison between tracheal intubation and the armoured laryngeal mask airway.
A prototype armoured laryngeal mask airway (LMA) was compared with tracheal intubation (ETT) for anaesthesia for adenotonsillectomy. Fifty-five children were randomised into the LMA group and 54 into the ETT group. During insertion of the LMA, peripheral oxyhaemoglobin desaturation (SpO2) < 94% occurred in ten patients (18.2%) and in seven patients (13%) during tracheal intubation (NS). ⋯ The LMA did not limit surgical access. Heart rate, MAP and blood loss in the LMA group were 110 +/- 21, 74 +/- 9 mmHg and 1.92 +/- 1.22 ml.kg-1 respectively, compared with 143 +/- 13 (P < 0.001), 85 +/- 12 mmHg (P < 0.001) and 2.62 +/- 1.36 ml.kg-1 (P < 0.05) with tracheal intubation. Fibreoptic laryngoscopy at the end of surgery in 19 patients in the LMA group revealed no blood in the larynx.(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Clinical Trial
Maternal positioning affects fetal heart rate changes after epidural analgesia for labour.
Adverse fetal heart rate (FHR) changes suggestive of fetal hypoxia are seen in patients with normal term pregnancies after initiation of epidural block for labour analgesia. It was our hypothesis that, in some parturients, these changes were a consequence of concealed aortocaval compression resulting in decreased uterine blood flow. We expected that the full lateral position compared with the wedged supine position would provide more effective prophylaxis against aortocaval compression. ⋯ The quality and efficacy of the block were assessed using VAS pain scores, motor block scores and sensory levels. The results demonstrated that there was no difference in the quality of analgesia provided nor in the incidence of asymmetric blocks. There was no difference in the observed incidence of FHR changes occurring during the initiation of the epidural block.(ABSTRACT TRUNCATED AT 250 WORDS)
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This study was undertaken to examine the effect of sevoflurane on right ventricular function, the safety of sevoflurane for one-lung ventilation and the effects of PEEP (positive end-expiratory pressure) to the dependent lung in this model using 12 open-chest sheep. Haemodynamic variables, including cardiac output, mean arterial blood pressure, right ventricular pressure and pulmonary arterial pressure, and right ventricular segment shortening (sonomicrometry) were measured. First, animals received 2.0, 3.0 or 4.0% sevoflurane for 20 min each, respectively, during two-lung ventilation to measure the dose-dependent haemodynamic effects of sevoflurane. ⋯ During one-lung ventilation the PaO2 was greater with 5 cm H2O PEEP 198 mmHg (+/- 25 SEM) than with ZEEP 138 mmHg (+/- 22) or with 10 cm H2O PEEP 153 mmHg (+/- 23) (P < 0.05). No differences in haemodynamic variables or segment shortening between ZEEP and PEEPs during one-lung ventilation were observed. We conclude that although sevoflurane causes a dose-dependent depression of right ventricular function, sevoflurane anaesthesia can be safely applied to one-lung ventilation, and that 5 cm H2O PEEP to the dependent lung can improve arterial oxygenation without causing changes in right ventricular function.