Anaesthesia
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Comparative Study Clinical Trial Controlled Clinical Trial
SCOTI vs. Wee. An assessment of two oesophageal intubation detection devices.
The SCOTI (Sonomatic Confirmation of Tracheal Intubation) is a newly marketed electronic device that relies on recognition of a resonating frequency for detection of tracheal intubation. It was compared with the modified Wee oesophageal intubation detection device, which works on a mechanical principle, in 50 elective surgical patients. All had simultaneous tracheal and oesophageal intubations. ⋯ The SCOTI device incorrectly identified 1 of 50 tracheal intubations and was unable to identify the position of another. It correctly identified all 50 oesophageal intubations. The SCOTI is no better than the simple, cheap and reliable Wee device.
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Comparative Study Clinical Trial Controlled Clinical Trial
Continuous versus intermittent thermodilution cardiac output measurement during orthotopic liver transplantation.
We evaluated intermittent and continuous thermodilution cardiac output data in 12 patients undergoing orthotopic liver transplantation. Measurements were performed at 16 predefined time points between induction of anaesthesia and 3 h after reperfusion of the liver graft. Cardiac output measurements yielded 192 data pairs (intermittent cardiac output range: 1.8-18.9 l.min-1, continuous cardiac output range: 3.3-20.0 l.min-1). ⋯ However, in the early phases after caval clamping and after reperfusion, accuracy was not acceptable. Only during these phases did the difference between the mean values of pulmonary artery blood temperature and rectal temperature increase (after caval clamping) or decrease (after reperfusion). In conclusion, despite acceptable levels of accuracy and precision between intermittent and continuous cardiac output measurement under stable conditions, both methods showed markedly decreased accuracy and precision in the early phases after caval clamping and after reperfusion, possibly owing to increased thermal noise.
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Randomized Controlled Trial Clinical Trial
The effect of subhypnotic doses of propofol on the incidence of pruritus after intrathecal morphine for caesarean section.
The effect of subhypnotic doses of propofol on intrathecal morphine-induced pruritus was studied in a prospective, randomly allocated, double-blind controlled trial. Fifty-eight women undergoing elective lower segment Caesarean section for a singleton fetus received spinal anaesthesia with 2.5 ml hyperbaric 0.5% bupivacaine and 0.2 mg of preservative-free morphine. They then received propofol 1 ml (10 mg) or Intralipid 1 ml (control group) intravenously after delivery. ⋯ No adverse side-effects were associated with this dose of propofol. There were no differences in the incidence of post-operative nausea and vomiting between the two groups. Subhypnotic propofol is not an effective treatment for intrathecal morphine-induced pruritus in women following Caesarean section.
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Randomized Controlled Trial Clinical Trial
A non-rebreathing coaxial anaesthesia system: dependence of end-tidal gas concentrations on fresh gas flow and tidal volume.
A non-rebreathing adaptation of the Bain coaxial anaesthesia circuit was developed in Nepal as a simple and economical anaesthetic system for underdeveloped countries. It was made by inserting a coaxial (Bain) tubing between an Ambu-E valve and an Ambu self-inflating bag. The present study examined the dependence of end-tidal gas concentrations on fresh gas flow and tidal volume during halothane/oxygen/air inhalation anaesthesia. ⋯ With increasing fresh gas flow rates, there were proportionate increases in the end-tidal concentrations of oxygen and halothane; with decreasing tidal volume and therefore less air dilution, there were proportionate increases in the end-tidal concentrations of carbon dioxide, oxygen and halothane. Both effects were statistically and clinically significant. Thus, when this system is used as described, the end-tidal concentrations of oxygen and halothane are highly dependent upon both the fresh gas flow and the tidal volume.
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The Short Form 36 was used to compare critically ill patients' premorbid quality of life with normal values and investigate any changes following 6 months convalescence. One hundred and sixty-six survivors completed the Short Form 36 at discharge from intensive care. The answers given by survivors were significantly lower than normal for all dimensions. ⋯ After 6 months, 95 questionnaires were returned. Patients who had suffered acute pathologies reported significant decreases in quality of life whilst other patients with pre-existing ill health reported significant improvement with reduced pain and better mental health, vitality and social function. This study suggests that quality of life of most patients admitted to intensive care is not as good as in the normal population but does not deteriorate except for those patients admitted after acute life-threatening events.