Anaesthesia
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Randomized Controlled Trial Clinical Trial
The influence of diamorphine on spinal anaesthesia induced with isobaric 0.5% bupivacaine.
In a randomised, double-blind study, the effect of addition of 1 mg of diamorphine to 4 ml of 0.5% bupivacaine for spinal anaesthesia was studied in two groups each of 30 patients presenting for either transurethral genito-urinary surgery, or for lower limb arterial surgery or inguinal herniorrhaphy. Addition of 1 mg diamorphine to intrathecal 0.5% bupivacaine produced a prolonged and satisfactory analgesia in more than half the patients undergoing lower limb arterial or inguinal surgery, and the analgesic requirements of the remainder during the first postoperative 24 h were much less than those who received bupivacaine alone. In the urological surgery set there were no significant differences between the group who received bupivacaine and diamorphine, and the group who received bupivacaine alone. The mixture of diamorphine 1 mg in 4 ml 0.5% bupivacaine was slightly less hypobaric (0.9981 at 37 degrees C) than bupivacaine alone.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison between propofol and desflurane anaesthesia for minor gynaecological laparoscopic surgery.
Fifty-seven healthy female patients who underwent gynaecological laparoscopic surgery received either desflurane or propofol for induction and maintenance of anaesthesia. Inhalational induction was generally well tolerated, and consciousness was lost in approximately 2 min (mean end-tidal concentrations of desflurane were 8.3% with 60% nitrous oxide, and 7.1% with oxygen). Recovery of consciousness and orientation were more rapid in patients in whom anaesthesia was maintained with desflurane than with propofol, but there were no differences in psychomotor function test scores at 30 min. The data suggest that desflurane provides controllable anaesthesia and rapid recovery of consciousness after laparoscopic surgery.
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A technique for teaching fibreoptic nasotracheal intubation is described. Fifty patients presenting for elective dental surgery received thiopentone by intermittent injection for induction and maintenance of anaesthesia whilst a trainee anaesthetist attempted to visualise the vocal cords using an intubating fibrescope. During endoscopy patients spontaneously breathed oxygen-enriched air and passage of the tracheal tube was facilitated by suxamethonium. ⋯ Changes in arterial blood pressure and heart rate were similar to those described in previous studies of tracheal intubation. Haemoglobin oxygen saturation remained above 95% in 43 patients, and above 93% in 46 patients; the lowest saturation recorded was 91%. Intermittent thiopentone provides good conditions for teaching fibreoptic nasotracheal intubation whilst maintaining arterial blood pressure and oxygen saturation.
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This is a report of a modification of the standard Macintosh laryngoscope blade to facilitate tracheal tube placement in cases of difficult visualisation of the larynx. The modification offers the unique advantage of a hinged blade tip, controlled by a lever on the handle of the laryngoscope which allows elevation of the epiglottis while decreasing the overall laryngoscopic elevation or levering movement required. It is an adaptation which can be applied to most laryngoscope blades, does not require any special training in its use and will prove useful for both routine intubations as well as those which may be difficult and associated with an anterior larynx.