Anaesthesia
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Randomized Controlled Trial Clinical Trial
The effect of epidural opioids on maternal oxygenation during labour and delivery.
The effects of epidural fentanyl on the incidence of maternal hypoxaemia during labour and on neonatal welfare were examined. Women were randomly allocated to receive one of two epidural infusions, bupivacaine 0.125% alone or bupivacaine 0.0625% with 2.5 micrograms.ml-1 fentanyl, and maternal arterial oxygen saturation was monitored continuously until delivery. ⋯ Similarly, the incidence of desaturation to SpO2 < or = 90% was greater in the fentanyl group than in controls (p = 0.02). There was no correlation between maternal oxygenation or plasma fentanyl concentration and neonatal welfare as measured by umbilical arterial and venous blood gas and acid base status, Apgar score and Neurologic and Adaptive Capacity Score.
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Randomized Controlled Trial Comparative Study Clinical Trial
Simulated difficult intubation. Comparison of the gum elastic bougie and the stylet.
A randomised study was carried out to compare the efficacy of the gum elastic bougie and the stylet in a simulated difficult intubation. A laryngoscopic assessment, as described by Cormack and Lehane, was made in 100 patients. A Grade 3 view was then simulated. ⋯ In the Stylet First Group (50 patients) the order was reversed. After two attempts the tube was correctly placed in the trachea in 96% of cases in the Bougie First Group compared to only 66% of cases in the Stylet First Group (p < 0.001). We recommend that a gum elastic bougie should be readily available and that anaesthetists should use it in preference to a stylet whenever a good view of the glottis is not immediately available.
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Randomized Controlled Trial Clinical Trial
Lack of efficacy of intra-articular opioids for analgesia after day-case arthroscopy.
A randomised double-blind placebo-controlled trial was undertaken to assess the analgesic efficacy of intra-articular opioids following arthroscopy of the knee. At the completion of surgery, patients received an intra-articular injection of: morphine 1 mg, buprenorphine 30 micrograms or 0.9% saline. There were no differences in pain scores among groups for the first 24 h postoperatively. We have found no clinical evidence for a peripherally-mediated opioid analgesic effect.
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Having used the Boyle's bottle vaporizer apparatus out of necessity in a developing country, the concentration of agent that had been administered was investigated retrospectively. Three anaesthetic agents, halothane, isoflurane and enflurane, were measured at different temperatures, using a Boyle's anaesthetic machine and a Boyle's bottle in circuit with a Magill breathing system connected to a Rascal II Agent Monitor. Bubbling a fresh gas flow of 5 l.min-1 through the anaesthetic liquids generated concentrations in excess of 12%. ⋯ The Boyle's bottle vaporizer may be used with modern anaesthetic agents such as halothane, isoflurane and enflurane. However, the limitations of and variations between vaporizers should be borne in mind. An agent monitor employed at the patient end of the circuit would be an important safety feature.
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A postal questionnaire aiming to ascertain the availability of cricothyrotomy and transtracheal ventilation equipment, and experience of its use, was sent to all tutors of the Royal College of Anaesthetists in the United Kingdom and Ireland. The response rate was 74.9%. Almost half of the respondents had experience of cricothyrotomy. ⋯ Seventy five percent of patients reported had eventual successful airway management with full recovery, while 9.6% had partial recovery and 15.4% died. Formal training of emergency airway management was practised in 14.2% of anaesthetic departments, while 73.6% had informal training. Twelve percent of the departments did not specifically teach their trainees the skill of emergency airway management.