Anaesthesia
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Randomized Controlled Trial Clinical Trial
The effect of variable-dose diazepam on dreaming and emergence phenomena in 400 cases of ketamine-fentanyl anaesthesia.
This randomised double-blind field study compared 400 anaesthetics using diazepam (0, 0.025, 0.5, 0.1, 0.175 mg.kg-1) with ketamine (1 mg.kg-1) and fentanyl (1 microg.kg-1) in Melanesian patients. Dreams were very common and generally positive in nature. A minimum of 0.1 mg.kg-1 of diazepam was needed to significantly reduce dreaming when compared with water (67.5% vs. 94.6%; p < 0.0001), and to significantly lower median (95% CI) emergence delirium scores (4 (3-4) vs. 6 (5-7)). ⋯ Higher diazepam doses significantly reduced the increase in blood pressure and heart rate at 3 and 6 min postketamine. When used with ketamine and fentanyl, 0.1 mg.kg-1 of diazepam has favourable psychic and cardiovascular effects. Lower diazepam doses generally had little effect whereas larger doses did not enhance the benefits further.
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Randomized Controlled Trial Comparative Study Clinical Trial
Use of the bougie in simulated difficult intubation. 2. Comparison of single-use bougie with multiple-use bougie.
We studied the success rates for tracheal intubation in 32 healthy, anaesthetised patients during simulated grade IIIa laryngoscopy, randomised to either the multiple-use or the single-use bougie. Success rates (primary end-point) and times taken (secondary end-point) to achieve tracheal intubation were recorded. ⋯ With either device, median [range] total tracheal intubation times for successful attempts were < 54 [24-84] s and there were no clinically important differences between these times. We conclude that the multiple-use bougie is a more reliable aid to tracheal intubation than the single-use introducer in grade IIIa laryngoscopy.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of the forces exerted during laryngoscopy using disposable and non-disposable laryngoscope blades.
The concern that re-usable equipment may be a source of cross-infection has prompted the increased use of disposable laryngoscope blades. We conducted a study investigating the duration of laryngoscopy and the peak force generated using various laryngoscope blades. Five blades were studied: one reusable Macintosh 3 blade, one disposable metal blade and three plastic disposable blades. ⋯ The mean duration of laryngoscopy with the collar off for the metal blades was 5.6 and 5.4 s, and with the plastic blades 10, 7.2 and 7.5 s (p < 0.0001). The duration of laryngoscopy with the collar applied for the metal blades was 7.1 and 7.5 s, and with the plastic blades 11.8, 9.7 and 9.0 s (p < 0.0001). The use of plastic blades results in both greater peak force and duration of laryngoscopy.