Anaesthesia
-
Randomized Controlled Trial Comparative Study Clinical Trial
Effects of a height and weight adjusted dose of local anaesthetic for spinal anaesthesia for elective Caesarean section.
In this prospective, randomised, double-blind study, we compared the effects of two dosage regimens. Pregnant patients at term were randomly assigned to two groups to be given diamorphine 0.4 mg in hyperbaric bupivacaine 0.5% 2.4 ml or diamorphine 0.4 mg in a volume of hyperbaric bupivacaine 0.5% adjusted according to the patient's height and weight. Adequate anaesthesia was provided in all patients in both groups. ⋯ Hypotension occurred in 71.7% vs. 50.0% of patients in the fixed dose and adjusted dose groups respectively (p = 0.035). In the fixed dose group, more patients required ephedrine to treat hypotension (79.5% vs. 56.8%, p = 0.022) and a larger median dose was administered (9 mg vs. 6 mg, p = 0.042). The decrease in mean (SD) arterial pressure was less in the adjusted group (35.0 (16.4) mmHg vs. 28.0 (13.5) mmHg, p = 0.036).
-
Randomized Controlled Trial Comparative Study Clinical Trial
Randomised, crossover comparison of the single-use SoftSeal and the LMA Unique laryngeal mask airways.
We performed a randomised, crossover, single-blind trial among 168 patients, to compare the single-use SoftSeal and LMA Unique laryngeal mask airways in spontaneously breathing adults. Size-3 and -4 laryngeal mask airways, inserted by experienced anaesthetists, performed equivalently for successful first-time placement (148 (91%) vs 155 (96%) for the SoftSeal and LMA Unique, respectively). The SoftSeal was more often rated as difficult to insert (27 (17%) vs 4 (3%); p < 0.001) and was more likely to show evidence of mucosal trauma after the first insertion (14 (10%) vs 5 (4%); OR 1.3 (95% CI 1.3-11.3); p < 0.05). ⋯ In contrast to the LMA Unique(trade mark), its cuff pressure did not increase during nitrous oxide anaesthesia (median (IQR [range]) decrease 3 (- 20-23 [-40-94]) cmH(2)O vs increase of 16 (-2-39 [-54-112]) cmH(2)O; p < 0.01). Both devices were equivalent for the success of first-time insertion and performed satisfactorily clinically. There were some performance differences, but either appears suitable for airway management in spontaneously breathing patients.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of the Flexiblade levering laryngoscope with the English Macintosh laryngoscope in patients with a poor laryngoscopic view.
The effectiveness of two laryngoscopes, the English Macintosh and the Flexiblade (a levering laryngoscope), were compared in a clinical setting. An investigation was carried out in 100 patients admitted for surgery under general anaesthesia, to compare intubation with the Flexiblade or the Macintosh laryngoscope. The patients had two anatomical characteristics that may predict difficult intubation - Mallampati score II and III, and a thyromental distance
-
Quality of life is often thought to be poor before and after intensive care unit admission. The aim of this study was to investigate changes in quality of life before and after intensive care. A prospective cohort study of 300 consecutive patients admitted to intensive care was performed in a Scottish Teaching Hospital. ⋯ Poor premorbid quality of life was demonstrated and appears to reduce after ICU discharge. For survivors there was a slow increase in physical quality of life to premorbid levels by the end of the first year but these remained lower than in the general population. ICU patients experience a considerable longer-term burden of ill health.