Anaesthesia
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Randomized Controlled Trial Clinical Trial
Peribulbar anaesthesia using a mixture of local anaesthetic and vecuronium.
The aim of this double-blind, randomised study was to assess the effects of the addition of 0.5 mg of vecuronium bromide to a standard local anaesthetic mixture used for peribulbar anaesthesia. We studied 60 patients undergoing regional anaesthesia for intra-ocular surgery and were primarily interested in the quality of globe and lid akinesia. ⋯ Eye movements assessed at both 5 and 10 min were significantly reduced in the vecuronium group (group B) (p < 0.05). We conclude that the addition of vecuronium at a dose of 0.5 mg to the standard local anaesthetic mixture improves the quality of globe and lid akinesia.
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Randomized Controlled Trial Clinical Trial
Pouch of Douglas block for laparoscopic sterilisation.
The use of local anaesthetic has been shown to reduce the incidence of pain after laparoscopic sterilisation and the need for opioid analgesia from day surgery. We investigated a technique in which a catheter is placed in the pouch of Douglas allowing repeated administration of local anaesthetic in the postoperative period. Forty patients were randomly allocated pre-operatively into one of two groups to receive in a double-blind manner either lignocaine 1% or normal saline. ⋯ Postoperative pain scores were significantly reduced (p < 0.05) after injection of lignocaine through the catheter. There were no complications related to the technique and no evidence of local anaesthetic toxicity. Lignocaine instilled into the Pouch of Douglas is an effective method for postoperative pain relief after laparoscopic sterilisation.
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Randomized Controlled Trial Clinical Trial
Respiratory complications associated with tracheal extubation. Timing of tracheal extubation and use of the laryngeal mask during emergence from anaesthesia.
Sixty patients were randomly allocated to one of three groups and the incidences of respiratory complications which occurred during emergence from anaesthesia were compared under the following three circumstances: tracheal extubation after the patient had regained consciousness (awake group); tracheal extubation while the patient was still anaesthetised (anaesthetised group); and the use of the laryngeal mask during emergence from anaesthesia (mask group). In the mask group, the laryngeal mask was inserted under deep anaesthesia before tracheal extubation and the lungs were ventilated through the laryngeal mask after tracheal extubation. In the awake group, straining (bucking) occurred in 18 patients and desaturation (arterial oxygen haemoglobin saturation < 95%) in two patients. ⋯ No respiratory complications occurred in two patients in the awake group, three patients in the anaesthetised group and 16 patients in the mask group. The incidence of respiratory complications during recovery from anaesthesia was significantly lower in the mask group than in the other two groups (pooled) (p < 0.001). Therefore, the use of the laryngeal mask after tracheal extubation decreases the incidence of respiratory complications during recovery from anaesthesia.
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Randomized Controlled Trial Clinical Trial
An evaluation of the factors influencing selection of the optimal size of laryngeal mask airway in normal adults.
The purpose of this randomised single blinded study was to determine the optimal size of laryngeal mask airway in the normal adult population, to test the validity of the current selection criteria and to determine if any externally measured anatomical variable correlated with optimal size. In each of 30 apnoeic anaesthetised adults weighting less than 100 kg, size 3, 4 and 5 laryngeal mask airways were inserted in random order by a skilled user and the cuff inflated to a standard pressure (60 cm H2O). Optimal size was based on four criteria in order of priority: number of attempts at placement, oropharyngeal leak pressure, fiberoptic score and percentage of vocal cords seen. ⋯ Potentially useful new strategies may be to use the size 5 in all adults, or a size 5 > or = 165 cm in height and size 4 for < 165 cm. We conclude that predicting the optimal size of laryngeal mask airway for individual adult patients is complex. The best size selection strategies involve use of the size 4 and 5 laryngeal mask airways in adults.