Anaesthesia
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Six hundred and forty patients received epidural analgesia for postoperative pain relief following major surgery in the 6-year period 1993-1998. Although satisfactory pain relief was achieved in over two-thirds of patients for a median duration of 44 h after surgery, one-fifth of patients (133 individuals) still experienced poor pain relief. Almost one out of three patients (194 individuals) had a problem with their epidural. ⋯ Seven patients had their epidural replaced and subsequently experienced excellent pain relief for a median of 77 h. Lack of resources prevented a further 480 patients from receiving the potential benefits of epidural analgesia. These results would suggest that the practical problems of delivering an epidural service far outweigh any differences in drug regimens or modes of delivery of epidural solutions.
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Randomized Controlled Trial Comparative Study Clinical Trial
Randomised double-blind comparison of ondansetron and droperidol to prevent postoperative nausea and vomiting associated with patient-controlled analgesia.
In a randomised, double-blind trial, we compared the use of ondansetron and droperidol for the prevention of nausea and vomiting after total abdominal hysterectomy, during patient-controlled analgesia with morphine. One hundred and forty-two patients were randomly allocated to one of two groups. All patients received a standardised general anaesthetic and postoperative analgesic regimen. ⋯ During the first 24 h after surgery, prophylaxis was successful in 26 of 66 patients given ondansetron (39%) compared with 36 of 71 patients given droperidol (51%). This difference was not statistically significant (Chi-squared = 1.766, p = 0.18). We conclude that in the regimens studied, ondansetron is not more effective than droperidol at preventing postoperative nausea and vomiting.
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Comparative Study
Leakage of fluid around high-volume, low-pressure cuffs apparatus A comparison of four tracheal tubes.
We studied the ability of high-volume, low-pressure tracheal tube cuffs (Portex Soft Seal, Portex Profile, Mallinckrodt Lo-Contour and Mallinckrodt Hi-Lo tubes) to prevent leakage of fluid into the airway, in a model trachea and lung. Five tubes (7.0 and 8.0 mm internal diameter) of each type were used. Each tube was inserted into the model trachea and the cuff inflated until the intracuff pressure reached either 20, 30 or 40 cm H2O. ⋯ The leak volume for the Soft Seal tube was less than that for the Profile or Lo-Contour tubes at all intracuff pressures (all p<0.05). Compared with the Hi-Lo tube, the volume leaking past the cuff for the Soft Seal tube was greater at an intracuff pressure of 20 cm H2O (p<0.05), whereas there was no significant difference between these two tubes at an intracuff pressure of 30 or 40 cm H2O. We conclude that the cuff of the Portex Soft Seal tube prevented leakage of fluid significantly more than that of the Portex Profile or Mallinckrodt Lo-Contour tubes, and to a similar degree to that of the Mallinckrodt Hi-Lo tube.
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Treatment in an intensive care unit can be stressful and may leave patients with persisting psychological symptoms that impair quality of life. This postal questionnaire study of patients who had previously been treated in a general adult intensive care unit showed that 38 (47%) of 80 patients who returned fully completed questionnaires reported clinically significant anxiety and depression as measured by the Hospital Anxiety and Depression Scale. ⋯ We describe a new measure of psychological distress specifically related to the experience of intensive care management, the Experience after Treatment in Intensive Care 7 Item Scale, and compare it to the other scales. The Experience after Treatment in Intensive Care 7 Item Scale shows that at least a proportion of the post-traumatic stress reported was directly attributable to the experience of treatment in the intensive care unit.