Anaesthesia
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Randomized Controlled Trial Clinical Trial
The SMART needle. A new Doppler ultrasound-guided vascular access needle.
Central venous access is an essential part of patient management in many clinical settings. Traditionally this has been achieved by a blind, external landmark guided technique which may not correlate exactly with the location of the vessel. We have prospectively evaluated the SMART needle, a new Doppler ultrasound guided vascular access device, in 40 patients, to evaluate whether it can improve on the standard technique. ⋯ No advantage was demonstrated in 'easy' internal jugular vein cannulations. Although ease of cannulation in difficult cases was subjectively improved, the differences in time to cannulation and number of passes between the groups failed to reach statistical significance and the complication rates were similar. However, the use of the SMART needle on two occasions enabled avoidance of carotid artery puncture by correctly distinguishing the artery from the vein, so that it may have a rôle in patients in whom difficult internal jugular venous cannulation is anticipated.
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A retrospective study of admissions to a Level 1 Trauma Centre, revealed 393 patients with traumatic cervical spine injuries. All 36 patients intubated urgently and 37 and 68 patients intubated between 30 min and 24 h of admission, were intubated orally, following a rapid sequence induction with the application of cricoid pressure and manual in-line stabilisation of the head and neck. ⋯ This technique for airway management is described in detail. It is a safe, familiar, and effective method for securing the airway in patients with cervical spine injury.
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Randomized Controlled Trial Comparative Study Clinical Trial
Dexmedetomidine as intramuscular premedication for day-case cataract surgery. A comparative study of dexmedetomidine, midazolam and placebo.
The effects of dexmedetomidine 1.0 microgram.kg-1, midazolam 20 micrograms.kg-1 and saline placebo were assessed in a double-blind, randomised study in 90 patients undergoing day-case cataract surgery under regional anaesthesia. The trial drug was injected into the deltoid muscle 45 min before the peri-ocular block. Dexmedetomidine 1.0 microgram.kg-1 decreased intra-ocular pressure before, during and after surgery. ⋯ Dexmedetomidine and midazolam produced a similar sedative effect of short duration. Dexmedetomidine induced a moderate decrease in blood pressure (p < 0.001 compared with placebo) and a slight but statistically significant decrease in heart rate throughout the study period (p < 0.001 compared with placebo). Dexmedetomidine 1.0 microgram.kg-1 intramuscularly, effectively reduced intra-ocular pressure and produced short-acting sedation with marginal cardiovascular effects; it may be a useful premedicant drug for elderly patients undergoing day-case cataract surgery under regional anaesthesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of 25 G and 27 G Whitacre needles for caesarean section.
Spinal needles with a pencil-point tip and those of a finer gauge are known to be associated with a lower incidence of postdural puncture headache. This study set out to determine if fine pencil-point needles were acceptably easy to use in routine clinical practice. Two hundred and twelve women undergoing elective Caesarean section were randomly allocated to receive a subarachnoid block using either a 25 G or 27 G Whitacre needle. ⋯ In the 25 G group, there was one severe postdural puncture headache which required an epidural blood patch and three mild headaches which resolved spontaneously. There were no postdural puncture headaches in the 27 G group. We conclude that the final choice of needle is a compromise between the ease of use and lower failure rate of the 25 G needle and the, as yet unproven, possibility of a lower incidence of postdural puncture headache with the 27 G needle.
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Randomized Controlled Trial Comparative Study Clinical Trial
Peri-operative effect of major gastrointestinal surgery on serum magnesium.
This study investigates the changes in serum magnesium levels after major gastrointestinal surgery and evaluates if Plasma-Lyte 148 used as maintenance fluid influences these changes in the peri-operative period. Thirty patients presenting for procedures ranging from anterior rectal resection to thoraco-abdominal cardio-oesophagectomy were randomly allocated into two groups, one of which received compound sodium lactate solution as the maintenance crystalloid during the intra- and postoperative period, and the other Plasma-Lyte 148, a magnesium-containing crystalloid solution. ⋯ The results showed a statistically significant (p < 0.05) reduction in the magnesium levels in both groups. The reduction was less marked in the Plasma-Lyte group but this did not achieve statistical significance (p > 0.05) compared with the compound sodium lactate group.