Anaesthesia
-
Randomized Controlled Trial Clinical Trial
The optimal dose of ketamine for caudal epidural blockade in children.
Sixty boys aged up to 9 years undergoing orchidopexy were randomly allocated to receive one of three solutions for caudal epidural injection: group A received 1 ml.kg-1 of 0.25% bupivacaine with 0.25 mg.kg-1 of preservative-free ketamine, group B received 1 ml.kg-1 of 0.25% bupivacaine with ketamine 0.5 mg.kg-1 and group C received 1 ml.kg-1 of 0.25% bupivacaine with 1 mg.kg-1 of ketamine. Postoperative pain was assessed by means of a modified Objective Pain Score and analgesia was administered if this score exceeded four. ⋯ There were no differences between the groups in the incidence of motor block, urinary retention, postoperative vomiting or postoperative sedation. Group C had a significantly higher incidence of behavioural side effects, including slightly odd behaviour, vacant stares and abnormal effect than groups A and B.
-
Randomized Controlled Trial Clinical Trial
Respiratory effects of spinal anaesthesia for caesarean section.
We report the changes observed in a number of pulmonary function tests performed on 36 patients undergoing Caesarean section under spinal anaesthesia. The tests comprised peak expiratory flow, forced expiratory volume in one second, forced vital capacity, forced expiratory volume in one second to forced vital capacity ratio and the maximal mid-expiratory flow. ⋯ These changes persisted for four hours after the induction of spinal anaesthesia. Administration of 35% oxygen by facemask failed to change significantly fetal umbilical vein pH or partial pressure of oxygen.
-
Randomized Controlled Trial Clinical Trial
Jaw thrusting as a clinical test to assess the adequate depth of anaesthesia for insertion of the laryngeal mask.
We have studied the efficacy of the loss of response to jaw thrust as a clinical test to assess adequate depth of anaesthesia for insertion of the laryngeal mask in 60 patients. After induction of anaesthesia with propofol (infused using a syringe driver), the patients were randomly allocated to one of two groups. In one group, insertion of the laryngeal mask was attempted immediately after the loss of verbal contact and in the other group, after the loss of motor response to a jaw thrust. ⋯ Conditions were significantly better when jaw thrust was used as a clinical test compared with loss of verbal contact (p < < 0.001). No marked haemodynamic depression occurred in any patient. Thus, jaw thrust is a reliable clinical test to assess the adequate depth of anaesthesia for uncomplicated insertion of the laryngeal mask after induction of anaesthesia with propofol.
-
Randomized Controlled Trial Clinical Trial
Gas leakage and the laryngeal mask airway. A comparison with the tracheal tube and facemask during spontaneous ventilation using a circle breathing system.
The ability of the laryngeal mask airway, tracheal tube and facemask to provide a leak free seal in a clinical setting was assessed by measuring the minimal fresh gas flows needed in a closed circle system during spontaneous ventilation on 60 subjects. The fresh gas flow was reduced until no spillage occurred from the pop-off valve. This fresh gas flow was taken to represent the sum of gas uptake by the subject and gas leakage from the circuit. ⋯ The fresh gas flow required for the facemask group was significantly higher than that for the laryngeal mask airway or tracheal tube groups (p < 0.01). There was no significant difference between the fresh gas flows required for the tracheal tube and laryngeal mask airway group. We conclude that the laryngeal mask airway provides as good a gas tight seal as a tracheal tube in this context and would be of benefit in reducing anaesthetic gas pollution.
-
Randomized Controlled Trial Clinical Trial
Economics of low-flow anaesthesia in children.
We have measured the consumption of isoflurane and fresh gas flows in 77 infants and children during 20 all-day operating sessions using either the enclosed Mapleson A or the circle absorber mode of the Carden 'Ventmasta' ventilator. The average consumption (SD) of isoflurane in 37 patients anaesthetised using the A mode of the Carden system with a mean fresh gas flow of 2.61 min-1 was 11.1 (4.2) g.h-1, while that in 40 patients anaesthetised using the circle absorber mode with a mean fresh gas flow of 1.21 min-1 was 4.7 (1.0) g.h-1. ⋯ With the addition of small bore breathing hoses the adult circle absorber system was practical to use in both infants and children. These findings should stimulate interest in the use of low-flow techniques in children.