Anaesthesia
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Letter Clinical Trial Controlled Clinical Trial
Intranasal fentanyl for postoperative analgesia after elective Caesarean section.
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Randomized Controlled Trial Clinical Trial
A new formulation of nasal fentanyl spray for postoperative analgesia: a pilot study.
Twenty-four gynaecological patients receiving postoperative patient-controlled analgesia were enrolled in an open cross-over pilot study evaluating two new formulations of nasal fentanyl spray. The primary outcome was the bioavailability of nasal fentanyl in comparison with intravenous fentanyl. This manuscript describes the clinical outcomes of quality of postoperative analgesia and patient acceptability. ⋯ There was no significant difference in side-effects. Four patients experienced mild nasal stinging and although 10 (42%) preferred intravenous administration, seven (29%) preferred intranasal and six (25%) had no preference. We conclude that these formulations of fentanyl, delivered as nasal spray, have potential clinical utility.
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Randomized Controlled Trial Multicenter Study Clinical Trial
To shape or not to shape...simulated bougie-assisted difficult intubation in a manikin.
Thirty anaesthetists attempted to place a derived 'optimal' curve bougie or a straight bougie in the trachea of a manikin, in a randomised cross-over study. A Grade 3 Cormack and Lehane laryngoscopic view was simulated. The anaesthetists were blinded to success (tracheal placement) or failure (oesophageal placement). ⋯ On a separate occasion, under identical laboratory conditions, 30 anaesthetists attempted to place a straight coudé (angled)-tipped bougie or a straight straight-tipped bougie in the trachea of a manikin. The success rates with the coudé- and straight-tipped bougies were 43 and 0%, respectively, giving a difference (95% confidence interval) of 43% (21-61%) between the two bougies (p < 0.001). These results suggest that bougies used to facilitate difficult intubation should be curved and have a coudé tip.
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Randomized Controlled Trial Clinical Trial
A 5-microm filter does not reduce propofol-induced pain.
We assessed the effectiveness of a 5-microm filter in reducing propofol-induced pain and determined whether any reduction is due to removal of contaminants or an alteration in flow characteristics. A total of 120 unpremedicated women (ASA 1-3, aged 18-70 yr) were randomly allocated to one of three equal-sized groups. In group A, propofol was drawn up and injected through an unfiltered plastic cannula. ⋯ The pain score for the patient was the taken as the most severe pain documented. The frequency and severity of pain were similar among groups. We conclude that a 5-microm filter does not reduce pain associated with injection of propofol drawn from a vial with a rubber bung.
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Current professional guidelines concerning information and consent for anaesthesia are a fair representation of English law. However, they reject the need for specific, written consent for anaesthesia, a position which is in accordance with other Western jurisdictions. ⋯ However, for the very reason that there are a large number of risks associated with anaesthesia (risks that are unknown to the majority of surgeons), together with the possibility of the courts moving towards a reasonable patient standard of information disclosure (as a result of the introduction of human rights legislation into English law), it is our view that the Association of Anaesthetists of Great Britain and Ireland should change their guidelines and advise anaesthetists to obtain separate, written affirmation from patients that certain risks and consequences of anaesthesia have been explained to them. In addition, a standardised consent form for anaesthesia may prove invaluable in retrospectively defending a claim of negligence founded around information disclosure, by recording exactly the risks and consequences of interventions discussed by the anaesthetist and the patient.