Anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Randomised controlled cross-over comparison of continuous positive airway pressure through the Hamilton Galileo ventilator with a Dräger CF 800 device.
In this controlled, randomised cross-over trial on 26 intensive care patients, we compared the effects on haemodynamic and respiratory profiles of continuous positive airway pressure delivered through the Hamilton Galileo ventilator or a Drager CF 800 device. We also compared the nursing time saved using the two approaches when weaning patients from mechanical ventilation. ⋯ However, there was a 10-fold reduction in nursing time using the Galileo ventilator compared with the Drager generator. We conclude that continuous positive airway pressure delivered through the Galileo ventilator is as efficient as a Drager device but consumes less nursing time.
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Randomized Controlled Trial Comparative Study Clinical Trial
Patient controlled analgesia for labour: a comparison of remifentanil with pethidine.
We compared the analgesic efficacy and safety of remifentanil and pethidine via patient controlled analgesia for women in established uncomplicated labour. Women received either remifentanil 40 microg with a 2-min lockout (n = 20) or pethidine 15 mg with a 10-min lockout (n = 19). ⋯ Maternal arterial oxygen saturation was similar in both groups. Neurologic and Adaptive Capacity Scores at 30 min were higher for remifentanil than for pethidine (median (interquartile range [range]) 36 (34.5-37 [32-39]) vs 34 (33-35 [30-35]), respectively; p = 0.003).
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B-type natriuretic peptide is known to predict outcome in congestive cardiac failure and myocardial infarction. We aimed to determine whether measurement of B-type natriuretic peptide would predict hospital mortality in patients admitted to an intensive care unit. We conducted a prospective observational cohort study in 78 consecutive patients. ⋯ B-type natriuretic peptide and cardiac troponin I levels taken on intensive care admission and 24 h after admission did not accurately predict hospital mortality for all patients, including patients with severe sepsis or septic shock (all p > 0.05). B-type natriuretic peptide levels were higher in patients with severe sepsis and septic shock (p = 0.02), in patients > or = 65 years (p = 0.04) and in patients with raised creatinine > or = 110 micromol.l(-1) (p = 0.02). We concluded that B-type natriuretic peptide, measured soon after admission to intensive care, does not usefully predict outcome after intensive care.
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The impact of cricoid pressure on laryngoscopy is unknown. We have developed a quantitative method of recording the laryngoscopic view using a rigid, zero-degree endoscope. We found that an image matching the laryngoscopist's view could be obtained by positioning the endoscope along the laryngoscopist's 'line of sight'. ⋯ We identified five subjects with a good initial view (anteroposterior length of the rima glottidis > 5 mm) who showed a marked deterioration in laryngoscopic view as cricoid pressure increased; in three of these subjects this progressed to obscure the larynx completely at a force of 30 N, 40 N and 60 N, respectively. We conclude that the effect of cricoid pressure on laryngoscopy is complex. However, in some individuals, a force close to that currently recommended (30 N) may cause a complete loss of the glottic view.