Anaesthesia
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Total intravenous anaesthesia may be most beneficial for day-case surgery with regard to quality of recovery, lack of complications and the ability to sustain an efficient throughput of patients. However, the technique can be applied to all forms of surgery and, with a little practice, consistent results will be achieved. ⋯ The commercially available 'Diprifusor', a target controlled infusion system for propofol, can facilitate the more widespread use of total intravenous techniques and allow their potential benefits to be applied and appreciated more widely. This review outlines some practical considerations that should enable a more confident approach to total intravenous techniques by anaesthetists who are unfamiliar with them.
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Review Comparative Study
Intravenous anaesthesia: manual infusion schemes versus TCI systems.
Propofol was first used to induce and maintain anaesthesia in the early 1980s. Several infusion regimens were described, some based on pharmacokinetic predictions. Advances in computing technology subsequently have allowed the development of portable target controlled infusion devices, with drugs delivered to achieve specific predicted target blood propofol concentrations. Assessments of propofol target controlled infusion systems in clinical practice and comparisons of 'Diprifusor' target controlled infusion systems with manual infusion are reviewed here.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of the effect of EMLA and semicircular subcutaneous anaesthesia in the prevention of tourniquet pain during plexus block anaesthesia of the arm.
In 54 patients who were to undergo surgery of the upper extremity in plexus block anaesthesia the effect of 5 g EMLA (group E) on tourniquet pain was examined and compared with the effect of a semicircular subcutaneous anaesthesia using 10 ml 0.25% bupivacaine (group B) or 10 ml 1% mepivacaine (group M). Among the patients with satisfactory brachial plexus analgesia allowing for surgery (n = 51), the incidence of tourniquet pain was not significantly different between groups E, M and B. Notably, there was no significant difference in the time of tourniquet application. We conclude that topical application of EMLA is as effective as a semicircular subcutaneous anaesthesia with mepivacaine or bupivacaine in the prevention of tourniquet pain during brachial plexus anaesthesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Postoperative respiratory function in children after abdominal surgery. A comparison of epidural and intramuscular morphine analgesia.
Thirty children undergoing urological and abdominal surgery were entered into a randomised trial comparing the effects of epidural and intramuscular morphine on postoperative respiratory function. The forced vital capacity and the forced expired volume in 1 s were measured before and 6 h after surgery and on each of the following seven days. Significant decreases (p < 0.01) in forced vital capacity and forced expired volume in 1 s were seen after surgery. ⋯ There were no statistically significant differences between the two groups during the study with respect to forced vital capacity and forced expired volume in 1 s. The quality of analgesia was better in the epidural morphine group than in the intramuscular morphine group. The incomplete recovery of pulmonary function suggests that pain is not the only cause of postoperative respiratory changes in these patients.
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Comparative Study Clinical Trial Controlled Clinical Trial
Evaluation of the HemoCue for measuring intra-operative haemoglobin concentrations: a comparison with the Coulter Max-M.
We compared haemoglobin concentration values obtained using a portable haemoglobinometer, the HemoCue, in the operating theatre with the results obtained by the Coulter Max-M in the laboratory. Haemoglobin concentrations were measured on 52 arterial blood samples obtained from 13 patients during aortic surgery, in theatre with the HemoCue and again by the Coulter Max-M. Twenty routine samples from the laboratory were also analysed by both methods. ⋯ The coefficients of repeatability of the 20 samples analysed in duplicate on each device were 0.26 g.dl-1 and 0.33 g.dl-1, respectively. The coefficients of variance were 0.74% (HemoCue) and 0.93% (Coulter). With adequate training and monitoring, the HemoCue provides comparable haemoglobin results for near-patient testing in theatre.