Anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of two airway aids for emergency use by unskilled personnel. The Combitube and laryngeal mask.
Many non-anaesthetists find airway control and intubation difficult. The laryngeal mask has been advocated for use by non-anaesthetists at cardiorespiratory arrests, whilst the Combitube is said to provide protection from aspiration. We wished to determine which device was easiest for unskilled staff to use. ⋯ Both devices were successfully placed in 24/26 patients. The median times to insertion were 40 s and 45 s for the laryngeal mask and Combitube, respectively, with two failures, both with the Combitube (p > 0.05); these were due to faulty operator technique. The Combitube may be a suitable alternative to the laryngeal mask for use in resuscitation by unskilled staff.
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Randomized Controlled Trial Comparative Study Clinical Trial
Clinical efficacy and pharmacokinetics of 1% ropivacaine and 0.75% bupivacaine in peribulbar anaesthesia for cataract surgery.
Peribulbar anaesthesia with 1% ropivacaine and 0.75% bupivacaine, both with hyaluronidase, was assessed in a prospective, randomised, double-blind study of 100 patients undergoing cataract surgery. Pharmacokinetic data were obtained from 22 subjects. Akinesia of the globe developed slightly more rapidly in the ropivacaine group, but this difference was only statistically significant at 2 min after injection of the local anaesthetic. ⋯ The dose-adjusted maximum concentration of ropivacaine was approximately twice that of bupivacaine with significantly higher values of the area under the concentration-time curves. No drug-related adverse effects were observed. We conclude that there are no clinically significant differences in the quality of the sensory and motor block between 1% ropivacaine and 0.75% bupivacaine when used for peribulbar anaesthesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Effective time to satisfactory intubation conditions after administration of rocuronium in adults. Comparison of propofol and thiopentone for rapid sequence induction of anaesthesia.
We determined the effective time to satisfactory intubation conditions after the administration of rocuronium 0.6 mg.kg-1 to 120 unpremedicated adult patients anaesthetised with propofol 2.5 mg.kg-1 or thiopentone 5 mg.kg-1. Intubation conditions were assessed in 10 subgroups of 12 patients at 30, 40, 50, 60 and 70 s. ⋯ The effective times to satisfactory intubation conditions in 50% and 90% (95% confidence intervals) of patients after rocuronium 0.6 mg.kg-1 were 34 (26-40) s and 61 (50-81) s in patients given propofol compared with 57 (48-69) s and 101 (79-167) s in patients given thiopentone. We conclude that rocuronium 0.6 mg.kg-1 may be a suitable alternative to suxamethonium during rapid sequence induction of anaesthesia with propofol in situations where suxamethonium is contraindicated.
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Randomized Controlled Trial Comparative Study Clinical Trial
Peri-operative tolerance to large-dose 6% HES 200/0.5 in major urological procedures compared with 5% human albumin.
We studied the long-term efficacy and safety of medium-molecular-weight hydroxyethyl starch (HES) administered in doses above 20 ml.kg-1 during major blood replacement therapy. Blood replacement for 50 patients used 6% HES 200/0.5 (HES group) or 5% albumin (ALB group) and additional blood components according to a defined protocol. We compared safety, efficacy and costs in 4 peri-operative days. ⋯ Blood loss (3810 (1632) ml (HES group) and 3455 (1733) ml (ALB group)) and the requirement for blood components was comparable. Costs were reduced by 35% (p < 0.05) in the HES group. We conclude that using 6% HES 200/0.5 as the only colloid for treatment even of large blood loss is a safe and economic alternative to albumin.
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Comment Letter Randomized Controlled Trial Clinical Trial
Manual ventilation via the laryngeal mask airway.