Anaesthesia
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A study was undertaken to compare the size of tracheal tube used for paediatric anaesthesia derived from either the diameter of the distal phalanx of the little or index finger, or from a standard formula (age in years/4 + 4.5 mm). The results showed that the diameter of the terminal phalanx was a poor predictor of the external diameter of the tube that provided the best fit. ⋯ The mean (SD) figures were 5.61 (0.75) and 5.70 (0.67) mm for the formula and the chosen tracheal tube, respectively. The use of the diameter of the terminal phalanx of either the little or the index finger is an unreliable measurement for the prediction of the tracheal tube size in paediatrics.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of ondansetron, metoclopramide and placebo as premedicants to reduce nausea and vomiting after major surgery.
In a randomised, double-blind study, we have compared the incidence of postoperative nausea and vomitting in 124 patients undergoing major lower limb orthopaedic surgery following oral premedication with temazapam and ondansetron 8 mg, metoclopramide 10 mg or placebo. They received a standardised epidural and general anaesthetic. An epidural mixture containing bupivacaine 0.1% and fentanyl 10 mg.ml-1 was infused postoperatively. ⋯ The incidence of vomiting significantly decreased from 55% and 43% in the placebo and metoclopramide groups, respectively, to 26% in the ondansetron group (p = 0.03). The incidence of nausea and vomiting in patients who had previously suffered was also significantly reduced from 67% and 68% in the placebo and metoclopramide groups, respectively, to 29% in the ondansetron group (p = 0.035). We conclude that oral premedication with ondansetron 8 mg was superior to metoclopramide 10 mg and placebo in preventing postoperative nausea and vomiting following major orthopaedic surgery in patients given epidural opioid analgesia.
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Breathing system filters are recommended for use during general anaesthesia. Manufacturers of gas sampling equipment recommend that gas is sampled from the 'machine side' of these filters, thereby avoiding contamination of the sampling line and waterlogging in the case of heat and moisture exchangers. ⋯ End-tidal carbon dioxide values were significantly lower at the machine side of the filter in both groups (p = 0.00001). The measurement error induced by the inclusion of the breathing system filter was significantly greater in the spontaneously breathing group (p = 0.0004).