Anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparative study of the incidence of sore throat with the laryngeal mask airway.
In a prospective study of 150 patients randomly assigned to three groups, we have compared the incidence and duration of sore throat after a standard anaesthetic regimen using three different methods of airway management: facemask; laryngeal mask, and laryngeal mask with insertion aid. The insertion aid is currently being developed by Portex Ltd and is intended both to facilitate accurate placement of the laryngeal mask and to reduce trauma during insertion. ⋯ When using the insertion aid the incidence was 18% and this was not statistically different from the facemask. The presence of blood on the laryngeal mask (22%) was less likely when the insertion aid was used (4%) (p < 0.02).
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Comparative Study
Mortality after spinal and general anaesthesia for surgical fixation of hip fractures.
One thousand, three hundred and thirty three patients who underwent anaesthesia for surgical fixation of a hip fracture were studied prospectively to assess the effects on outcome of general and spinal anaesthesia. There were no significant differences between the groups in risk factors, length of hospital stay or mortality rates after 30 days or one year. The data presented may be useful for those wishing to audit anaesthetic services provided to patients with hip fracture.
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Case Reports
Cerebrospinal fluid cutaneous fistula. An unusual complication of epidural anaesthesia.
We describe two cases of cerebrospinal fluid-cutaneous fistula following epidural anaesthesia used for postoperative pain relief. In each case spinal headache occurred only after removal of the catheters and both patients were treated successfully with autologous blood patches.
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A new approach to the internal jugular vein is described which keeps the head and neck in the neutral position and uses bony and cartilaginous landmarks for guidelines. Venous puncture is made along an axial line drawn superiorly from the lateral edge of the bony depression caused by the insertion of the sternocleidomastoid muscle on the superior edge of the clavicle. This line, at the level of the cricoid cartilage, lies directly over the internal jugular vein. ⋯ Subsequently the internal jugular vein was cannulated successfully using the developed technique in 20 consecutive trauma patients with suspected cervical instability. An average of 1.2 (0.2) (range 1-3) attempts were made per patient to locate the vein and there were no complications. We propose this technique as a safe and reliable method of gaining central venous access in patients with possible cervical spine injury following trauma.
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The position adopted during sleep by 52 pregnant women and 31 age-matched nonpregnant control subjects was studied. The pregnant group were all beyond the 30th week of gestation. In the pregnant group, 40 (77%) adopted a left tilt, 11 (21%) a right tilt and one (2%) was supine. ⋯ Closer analysis of the position adopted by the pregnant group showed: 33 adopted a full left 90 degrees tilt, five a left 60 degrees tilt, two a left 30 degrees tilt, 11 adopted a full 90 degrees right tilt and only one was supine. There was a significant difference between the sleeping positions of the pregnant and the control groups (p < 0.001). The majority of the pregnant group adopted a sleeping position that reduced the likelihood of aortocaval compression syndrome.