Anaesthesia
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Aeromedical transport of mechanically ventilated critically ill patients is now a frequent occurrence. However, the performance of the air filled tracheal tube cuff at altitude has not been studied in vivo. ⋯ With air providing the seal in the cuff the mean rise in cuff pressure was 23 cmH2O, which took the pressures above the critical perfusion pressure of the tracheal mucosa. This could lead to tracheal injury.
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Case Reports
Local anaesthesia and sedation for rigid bronchoscopy for emergency relief of central airway obstruction.
We report three experiences that illustrate the use of local anaesthesia for rigid bronchoscopy. All patients were acute emergencies, with life-threatening central airway problems. Instruments were inserted after the airway was anaesthetised using a technique that owes much to mid 20th Century methods for inserting endobronchial blockers. ⋯ Concomitant sedation reduced the unpleasantness of the experience in a way that in the past could only be dealt with by careful attention to the humanitarian elements of detail. Problems of oxygenation were ameliorated by periodically superimposing intermittent jetting with a Sanders injector fed from the oxygen pipeline. A need for developing and refining topical and other local anaesthetic techniques for rigid bronchoscopy is anticipated with the expansion of services for tracheo-bronchial stenting and lasering.
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Randomized Controlled Trial Clinical Trial
A randomised, controlled study of peri-operative low dose s(+)-ketamine in combination with postoperative patient-controlled s(+)-ketamine and morphine after radical prostatectomy.
In a randomised, double-blind prospective study we compared the effects on postoperative pain and analgesic consumption of intra-operative s(+)-ketamine (100 microg.kg-1 bolus and a continuous infusion of 2 microg.kg-1.min-1) followed by postoperative patient-controlled analgesia with morphine (1 mg per bolus) plus s(+)-ketamine (0.5 mg per bolus), or intra-operative saline followed by postoperative patient-controlled analgesia morphine (1 mg per bolus) alone. A total of 28 male patients undergoing radical prostatectomy were studied. ⋯ Pain scores at rest were significantly lower in the ketamine/morphine group across the 48-h study period (p = 0.01). No significant differences were found in pressure algometry measurements or the occurrence of adverse effects.