Anaesthesia
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Randomized Controlled Trial Clinical Trial
The effect of co-induction with midazolam upon recovery from propofol infusion anaesthesia.
Forty-eight patients undergoing day-case anaesthesia were asked to complete pre- and postoperative tests of psychomotor function in order to study the influence of co-induction with midazolam in conjunction with propofol/alfentanil anaesthesia on postoperative psychomotor recovery. The study was placebo controlled and double blind with patients receiving either 0.03 mg.kg-1 of midazolam or saline 2 min before induction of anaesthesia with propofol and alfentanil. ⋯ The study confirmed that co-induction with a subanaesthetic dose of midazolam reduced the induction dose of propofol by up to 50%. We conclude that co-induction with midazolam reduces psychomotor recovery in the immediate postoperative phase following propofol infusion anaesthesia.
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Randomized Controlled Trial Clinical Trial
Intubating conditions using cisatracurium after induction of anaesthesia with thiopentone.
We studied tracheal intubation conditions produced by the muscle relaxant, cisatracurium, following induction of anaesthesia with fentanyl (2 micrograms.kg-1) and thiopentone (6 mg.kg-1). Sixty patients were randomly assigned to receive cisatracurium in a single bolus dose of either 0.15 or 0.20 mg.kg-1. ⋯ The intubating conditions were better after the larger dose. Our results suggest that when anaesthesia is induced using thiopentone, a dose of 0.20 mg.kg-1 of cisatracurium is recommended to ensure satisfactory intubating conditions.
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Multicenter Study
Postoperative symptoms at home following day-case surgery in children: a multicentre survey of 551 children.
The incidence and duration of postoperative symptoms in children at home following day-case anaesthesia and surgery was evaluated using a questionnaire completed by parents of 551 children aged 4 months to 13.4 years (mean 3.8 years). They also evaluated the instructions given in hospital for care at home. The incidence of all symptoms was highest at home on the day of the operation. ⋯ Undertreatment of nausea in hospital was evident as only two children had received anti-emetics, even though 61 were reported to have emetic symptoms. Administration of effective anti-emetics should be encouraged, as emetic symptoms in hospital were the most significant predictor of nausea and vomiting at home. Treatment of pain at home and instructions for treatment of pain need to be improved.
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Randomized Controlled Trial Clinical Trial
The effect of a toothguard on the difficulty of intubation.
Dental damage is the most common reason for complaints against anaesthetists. The purpose of this study was to investigate the common belief that the use of a toothguard at the time of intubation causes intubation to be more difficult. We studied 80 patients, half of whom were intubated with a toothguard in situ and the other half intubated without a toothguard. ⋯ The median time to intubation in the group with a toothguard was 24 s and the median time to intubation in the group without a toothguard was 17 s. The difference of 7 s in the time to intubation was statistically significant (p = 0.0003). As the recorded times also included the time taken to insert the toothguard, we do not regard this result to be clinically significant and believe that anaesthetists should think carefully before disregarding this simple protective device.
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Comment Letter Case Reports
Complete airway obstruction during awake fibreoptic intubation.