Anaesthesia
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Randomized Controlled Trial Comparative Study
Comparison of forced-air warming and electric heating pad for maintenance of body temperature during total knee replacement.
We conducted a randomised controlled trial to compare the efficacy of forced-air warming (Bair Hugger(trade mark), Augustine Medical model 500/OR, Prairie, MN) with that of an electric heating pad (Operatherm 202, KanMed, Sweden) for maintenance of intra-operative body temperature in 60 patients undergoing total knee replacement under combined spinal-epidural anaesthesia. Intra-operative tympanic and rectal temperatures and verbal analogue score for thermal comfort were recorded. There were no differences in any measurements between the two groups, with mean (SD) final rectal temperatures of 36.8 (0.4) degrees C with forced-air warming and 36.9 (0.4) degrees C with the electric pad. The heating pad is as effective as forced-air warming for maintenance of intra-operative body temperature.
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Randomized Controlled Trial Comparative Study
A comparison of cyclizine and granisetron alone and in combination for the prevention of postoperative nausea and vomiting.
We conducted a randomised double-blinded study of 960 women undergoing day-case surgery to determine whether combination anti-emetic therapy of granisetron and cyclizine was more effective at decreasing the incidence of postoperative nausea and vomiting than these agents used alone. The women were randomly allocated to three groups to receive intravenous granisetron 1 mg, cyclizine 50 mg or both before induction of general anaesthesia. ⋯ There were no differences in the anaesthetic techniques used in the three groups. We conclude that the risk of postoperative nausea and vomiting is less with cyclizine and granisetron given together than with either given alone.
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Using a before and after study design, we compared protocolised weaning from mechanical ventilation with usual non-protocolised practice in intensive care. Outcomes (duration of mechanical ventilation, duration of intubation, intensive care stay) and complications (re-intubations, tracheostomy, mortality) were compared between baseline (Phase I) and following implementation of protocolised weaning (Phase II). Over the same period, we collected data in a second (reference) unit to monitor practice changes over time. ⋯ There were significantly more tracheostomies in Phase II (p = 0.004). The reference unit demonstrated no statistically significant differences in study outcomes or complications between Phases. Protocolised weaning did not reduce the duration of mechanical ventilation and was not associated with an increased rate of re-intubation or intensive care unit mortality.
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Case Reports
Total spinal anaesthesia after an attempted brachial plexus block using the posterior approach.
A 66-year-old patient scheduled for elective shoulder surgery underwent a brachial plexus block using the posterior approach. Shortly after injection of the local anaesthetic, he rapidly became unresponsive and apnoeic. We identify the possible reasons for this occurrence and discuss the place of the posterior approach in brachial plexus anaesthesia.