Anaesthesia
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Randomized Controlled Trial Clinical Trial
Teaching fibreoptic intubation in anaesthetised patients.
One hundred ASA grade 1 and 2 patients requiring orotracheal intubation for various general surgical procedures were randomly assigned to receive either expert rigid laryngoscopic or novice fibreoptic orotracheal intubation under total intravenous anaesthesia. Five anaesthesia residents in the 4th year, with no prior experience in fibreoptic laryngoscopy, participated in a fibreoptic training course, viewing two instructional videos and practising on the intubation manikin. Each resident intubated 20 patients in a randomised fashion either as an expert laryngoscopist or as a fibreoptic novice. ⋯ The haemodynamic profile was similar for fibreoptically intubated and conventionally intubated patients and there was no difference between the first two or the last two fibreoptic or rigid intubations. The study was designed to detect a difference of 10% in means (assuming alpha = 0.05 and beta < or = 0.2). The incidence of postoperative sore throat, dysphagia or hoarseness was similar in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Comparative Study Clinical Trial
Intra-ocular pressure during cardiopulmonary bypass--a comparison of crystalloid and colloid priming solutions.
Raised intra-ocular pressure secondary to alterations in plasma oncotic pressure has been implicated in the development of optic neuropathy after cardiopulmonary bypass. Patients presenting for open heart surgery received either crystalloid (n = 9) or colloid (n = 10) priming solutions for cardiopulmonary bypass. No differences in intra-ocular pressure or plasma oncotic pressure occurred between the groups before the onset of cardiopulmonary bypass. ⋯ At the same time plasma oncotic pressure decreased from approximately 20 mmHg in both groups to 10.6 mmHg with crystalloid and 15.7 mmHg with colloid primed cardiopulmonary bypass solutions (p < 0.05). Over the following hour of cardiopulmonary bypass, intra-ocular pressure and plasma oncotic pressure tended to return towards their pre-cardiopulmonary bypass values. Changes in plasma oncotic pressure, through fluid shifts, may have contributed towards this unexpected increase in intra-ocular pressure with crystalloid primed cardiopulmonary bypass.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of different modes of noninvasive ventilatory support: effects on ventilation and inspiratory muscle effort.
The aims of noninvasive ventilation include the correction of hypoventilation and unloading of inspiratory muscles. Volume cycled flow generators, bi-level positive airway pressure and continuous positive airway pressure techniques have all been used with face and nasal masks. We have compared these modes of ventilatory support, administered by a nasal mask in stable, awake outpatients with chronic obstructive pulmonary disease or neuromusculo-skeletal disease in respect of their effects on ventilation, inspiratory muscle effort and oxygen saturation. ⋯ Only the volume cycled flow generator increased minute ventilation significantly. Ventilation and inspiratory muscle effort were unaffected by continuous positive airway pressure but oxygen saturation was lower than during spontaneous ventilation. In awake, stable outpatients acclimatised to nasal ventilation there were no clinically significant differences between volume cycled flow generator and bi-level positive airway pressure techniques, but continuous positive airway pressure was less effective.