Anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Difficulties in spinal needle use. Insertion characteristics and failure rates associated with 25-, 27- and 29-gauge Quincke-type spinal needles.
The effect of different size (25-, 27- and 29-gauge) Quincke-type spinal needles on the incidence of insertion difficulties and failure rates was investigated in a randomised, prospective study with 300 patients. The needle size was randomised but the insertion procedure was standardised. The time to achieve dural puncture was significantly longer with the 29-gauge spinal needle compared with the larger bore needles and was due to the greater flexibility of the thin needle. ⋯ Postoperatively, no postdural puncture headaches occurred in the 29-gauge spinal needle group, whilst in the 25- and 27-gauge needle groups, the postdural puncture headache rates were 7.4% and 2.1% respectively. The incidence of backache was similar in all study groups. We conclude that dural puncture with a 29-gauge spinal needle is clinically as easy as with larger bore needles and its use is indicated in patients who have a high risk of postdural puncture headache.
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A previously fit 20-year-old man presented with a large haemothorax following a stab wound to the left chest. Pre-operative airway assessment indicated that tracheal intubation would be routine. ⋯ At operation, the patient's common carotid artery was found to have been perforated close to its origin on the aorta. The patient made an uneventful recovery.
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This observational study examined whether specific characteristics of 1168 patients admitted to a general intensive therapy unit had changed over 4 years. The patients' age, diagnosis, severity of illness on admission (APACHE score), duration of management and outcome were recorded prospectively. The risk of hospital mortality was calculated using the APACHE score modified by the appropriate coefficient for presenting diagnosis. ⋯ There was a significant reduction in duration of admission with 70% of patients being admitted for < or = 3 days in 1988-89 while a similar proportion were admitted for a week in 1985-86. Approximately 40% of patients in each year were admitted with a risk of hospital mortality of < or = 10%; such patients received only a short period of intensive care and had a low mortality in the intensive therapy unit. A group of patients with a low predicted (and actual) mortality rate was identified; such patients may be more appropriately managed on a high dependency unit.
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In developing countries like Nepal, anaesthetic compressed gases, especially nitrous oxide, are expensive and in short supply and anaesthetic techniques must equally use oxygen and volatile anaesthetics sparingly. We have designed a non-rebreathing anaesthetic system which meets these requirements. An Ambu-E anaesthetic valve and self-inflating Ambu bag connected to a Bain system form a non-rebreathing system which uses ambient air to supplement a mixture of low flow oxygen and halothane. ⋯ A graphical analysis of gas flow predicts that the system is almost 100% efficient, in that almost all of the oxygen and halothane will enter the alveoli. Our experience confirms that this is a safe, simple and economical method for inhalation anaesthesia. We recommend it for locations where anaesthetic machines and mechanical ventilators are lacking, and where medical oxygen is in short supply.