Anaesthesia
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Letter Case Reports
Percutaneous dilational trachestomy in the morbidly obese.
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Randomized Controlled Trial Clinical Trial
A prospective randomised controlled study of patient-controlled propofol sedation in phobic dental patients.
The safety and effectiveness of patient-controlled propofol sedation was prospectively assessed in 18 healthy, phobic dental patients. Using a randomised, crossover design each patient received two sessions of equivalent dental treatment under patient-controlled or clinician-controlled propofol sedation. The patient-controlled technique used 29.8% less drug (time-weighted dose) than the clinician-controlled method (p = 0.011). ⋯ Patient-controlled sedation produced a greater reduction in dental and general anxiety compared with clinician-controlled sedation, but the difference did not reach statistical significance. Three times the number of patients expressed a preference for the patient-controlled, compared with the clinician-controlled, technique. Patient-controlled sedation provides safe and acceptable intra-operative anxiolysis for phobic dental patients, but with reduced propofol dosage.
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Randomized Controlled Trial Comparative Study Clinical Trial
Randomised double-blind comparison of fentanyl, mivacurium or placebo to facilitate laryngeal mask airway insertion.
In a double-blind randomised study, we compared conditions during insertion of the laryngeal mask airway in 150 patients who received either fentanyl 1 microg.kg-1, mivacurium 0.04 mg.kg-1 or normal saline, before induction of anaesthesia with propofol 2 mg.kg-1. Insertion conditions, including mouth opening, swallowing, gagging or coughing, head or limb movement and ease of insertion, were each graded using a three-point scale. ⋯ Insertion conditions were similar between fentanyl and mivacurium, while both prolonged apnoea. Fentanyl and mivacurium are equally effective in facilitating insertion of the laryngeal mask airway following anaesthetic induction with propofol.
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The aim of this study was to determine whether infusion sets containing antisyphon devices increased the time to initial flow from syringe drivers. The antisyphon devices assessed were those manufactured by B Braun, Wescott and Vygon. Each device was placed between a 50-ml syringe and a spiral extension set and primed with saline. ⋯ At 2 ml.h-1 the start-up time was significantly longer with all the antisyphon sets compared with the control (p < 0. 0001). At higher infusion rates the differences between the antisyphon sets and the control were less pronounced. Clinicians who use syringe driver infusions should be aware of this delay between the activation of the infusion pump and the onset of flow and take steps to prevent it.