Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Randomized Controlled Trial Comparative Study Clinical Trial
Speed and ease of tracheal intubation: priming with mivacurium compared with succinylcholine.
This study examined the efficacy of mivacurium priming (0.015 mg.kg-1) with five minutes between the priming and intubating doses by comparing the effects of one, two and three times the ED95 dose (0.075 mg.kg-1) of mivacurium after priming (Groups 1, 2 and 3, respectively), with a saline prime and 2 x ED95 mivacurium (Group 4) or 1 mg.kg-1 dose of succinylcholine (Group 5). The time from the intubating dose injection to intubation was measured and intubating conditions were rated on a five-point scale with 4 being optimal and 0 being failure. Mean times (+/- SEM) in seconds between the administration of the intubating dose and tracheal intubation were: 106.4 +/- 5.1, 89.6 +/- 6.7, 81.9 +/- 2.7, 169.9 +/- 7.8 and 82.9 +/- 3.5 for Groups 1-5 respectively. ⋯ Scores for Groups 2, 3 and 5 were higher than those of Group 1 (P < 0.05). The data demonstrated that (1) priming with mivacurium shortens the intubation time and is accompanied by good intubating conditions with doses 2x and 3x ED95, and (2) intubating times and conditions similar to those achieved with succinylcholine can be obtained using mivacurium 2x (total dose 0.150 mg.kg-1) or 3 x ED95 (total dose 0.215 mg.kg-1) with a five-minute priming interval. Priming provides an alternative technique in those clinical circumstances where succinylcholine is contraindicated.
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Randomized Controlled Trial Comparative Study Clinical Trial
Post-tonsillectomy infiltration with bupivacaine reduces immediate postoperative pain in children.
Pain management after tonsillectomy in children remains a dilemma for the anaesthetist. A previous study demonstrated that the administration of lidocaine 1% topical spray to the peritonsillar fossae before tracheal extubation provided considerable immediate postoperative pain relief in infants and children. However, the pain relief was of short duration. ⋯ Peritonsillar infiltration of bupivacaine provided superior immediate postoperative analgesia as reflected by lower recovery room pain scores (P < 0.05) and opioid requirements (P < 0.01). Ward pain scores and analgesic requirements were similar among groups. Peritonsillar infiltration of bupivacaine 0.5% with 1:200,000 epinephrine provides better post-tonsillectomy pain control in the immediate postoperative period than bupivacaine spray or placebo.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of percutaneous and operative tracheostomies in intensive care patients.
The aim of our study was to compare the complication rate of convenional surgical and percutaneous dilational tracheostomies performed under general anaesthesia in critically ill patients. Fifty-three consecutive patients whose lungs were mechanically ventilated and who required tracheostomy were randomised to undergo either conventional surgical tracheostomy (n = 28) in the operating room or percutaneous dilational tracheostomy (n = 25) in the intensive care unit under general anaesthesia. All of the procedures were successfully completed. ⋯ In the surgical tracheostomy group, there were two patients with cuff leaks, one with a stomal infection and one with a pneumothorax. None of these complications occurred after percutaneous, dilational tracheostomy. We conclude that the low incidence of complications in both groups indicates that percutaneous dilational tracheostomy can be performed as safely in the intensive care unit with general anaesthesia as surgical tracheostomy can be performed in the operating room.
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Clinical Trial
Lightwand intubation: II--Clinical trial of a new lightwand for tracheal intubation in patients with difficult airways.
Lightwands have been used to assist in the tracheal intubation of patients with difficult airways for many years. A new lightwand (Trachlight) with a brighter light source and a flexible stylet permits both oral and nasal intubation under ambient light. This study reports the effectiveness of the Trachlight in tracheal intubation in patients with difficult airways. ⋯ The tracheas of these two patients were intubated successfully using a fibreoptic bronchoscope. Orotracheal intubation was successful in all patients in Group 2 using the Trachlight with a mean (+/- SD) time-to-intubation of 19.7 +/- 13.5 sec. Apart from minor mucosal bleeding (mostly from nasal intubation), no serious complications were observed in any of the study patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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The effects of positive end-expiratory pressure (PEEP) and lung compliance (CL) on delivered tidal volume (VTdel) and ventilator output were evaluated in the following anaesthesia machine/ventilator systems: Narkomed III with a Model AV-E ventilator (III/AV-E system) and an Ohmeda Modulus II with either a 7810 anaesthesia ventilator (II/7810 system) or a Model 7000 anaesthesia ventilator (II/7000 system). With a standard circle anaesthesia breathing circuit connected to a test lung simulating CL, gas flow was measured and integrated over time at each combination of VT settings (VTset), 500 ml or 1000 ml; CL settings, 0.15 to 0.01 L.cm H2O-1 decreased incrementally; and PEEP settings, 0 to 30 cm H2O increased in 5-cm H2O increments. ⋯ As CL decreased to 0.01 L.cm H2O-1 and PEEP increased to 30 cm H2O, at VTset of 500 ml and 1000 ml, respective VTdel decreased linearly to 251 +/- 6 ml and 542 +/- 7 with the III/AV-E, 201 +/- 5 and 439 +/- 5, with the II/7810, and 181 +/- 4 and 433 +/- 7 ml with the II/7000 (P < 0.05 among the three systems). Loss in VTdel due to PEEP alone, which increased only slightly when VTset was increased, accounted for an increasingly greater percentage of VTset as it was decreased, which was less pronounced with low CL.(ABSTRACT TRUNCATED AT 250 WORDS)