Anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Learning fibreoptic endoscopy. Nasotracheal or orotracheal intubations first?
We have studied the extent to which learning fibreoptic nasotracheal endoscopy first helped anaesthetists to learn fibreoptic orotracheal endoscopy later, and vice versa. After preliminary training on a bronchial tree model, 30 anaesthetic trainees were randomly allocated to the nasal first/oral second group, who performed 10 nasal intubations followed by 10 oral intubations, or the oral first/nasal second group, who performed 10 oral intubations followed by 10 nasal intubations, in anaesthetised, ASA group I or II patients undergoing elective oral or general surgery. ⋯ The mean (SD) total endoscopy time for all the endoscopies (both nasal and oral) in the nasal first/oral second group [1196 (162) s] was not significantly different from that for all the endoscopies in the oral first/nasal second group [1193 (188) s]. Because there is no advantage or disadvantage to be gained in starting to learn either type of endoscopy first, graduated training programmes can be planned according to the availability of suitable patients for fibreoptic intubation, without instructors needing to consider whether trainees make better progress if they learn one technique before the other.
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Randomized Controlled Trial Clinical Trial
Epidural catheter fixation: subcutaneous tunnelling with a loop to prevent displacement.
A method of fixing the epidural catheter by subcutaneous tunnelling and looping was devised. A prospective, randomised, double-blind, clinical trial was conducted in 68 adult patients, where postoperative pain relief was planned by thoracic epidural analgesia. In the tunnelled group (n = 34), the epidural catheter was fixed with a subcutaneous tunnel and loop, whereas in controls (n = 34), a simple loop of epidural catheter was left over the skin without tunnelling. ⋯ The method described allows the catheter to lie flat on the skin and outward traction of the catheter during movement of patients is dampened by the interposed loop which protects it against dislodgement. At the time of removal, both ends of the catheter can be removed under direct vision. In conclusion, we recommend this fixation method in cases where epidural analgesia is to be used for postoperative pain relief.
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Randomized Controlled Trial Comparative Study Clinical Trial
Intrathecal alfentanil with and without bupivacaine for analgesia in labour.
Combined spinal-epidural (CSE) for analgesia in labour is widely used as a method of providing pain relief while minimising motor blockade. Aiming to further reduce the associated motor weakness, we investigated the use of alfentanil alone as the initial intrathecal injection in a double-blind study. Thirty women were randomly allocated to receive either alfentanil 0.25 mg with bupivacaine 2.5 mg intrathecally, or alfentanil 0.25 mg in the same volume. ⋯ Sixty per cent of women receiving the alfentanil-bupivacaine mixture demonstrated an impaired ability to straight leg raise compared with none of the women in the alfentanil-saline group (p < 0.01). The incidence of adverse effects in mother and fetus was similar in both groups. We conclude that intrathecal alfentanil 0.25 mg alone as part of a CSE technique provides rapid analgesia of satisfactory quality without detectable motor blockade.