Anaesthesia
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Randomized Controlled Trial
The efficacy of pharyngeal packing during routine nasal surgery--a prospective randomised controlled study.
The efficacy of pharyngeal packing in the prevention of postoperative nausea and vomiting (PONV) in patients undergoing nasal surgery was evaluated in a prospective randomised controlled study. The effect of the presence of the pharyngeal pack on the incidence of postoperative sore throat was also assessed. ⋯ The absence of a pharyngeal pack was not associated with an increase in postoperative aspiration or vomiting. We conclude that the routine placement of pharyngeal packs during uncomplicated nasal surgery has no effect on the incidence of PONV and will increase the incidence of postoperative sore throat.
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Randomized Controlled Trial Comparative Study
A comparison of oral midazolam and nitrous oxide sedation for dental extractions in children.
The aim of the study was to compare oral midazolam and inhaled nitrous oxide as sedative agents during the management of children aged 5-10 years presenting for extraction of primary teeth under local anaesthetic. Subjects required two visits for the extraction of four primary teeth, one in each quadrant of the mouth, and were randomly allocated to be given nitrous oxide 30% in oxygen or oral midazolam 0.3 mg.kg(-1) at the first visit, the other technique being used at the second visit. Vital signs, sedation levels and behavioural scores were recorded, and postoperative recall and satisfaction were reported by the patients. ⋯ Physiological parameters remained within acceptable clinical limits for both types of sedation. Oral midazolam was considered acceptable by 59% and was preferred by 36%. Oral midazolam sedation in 5 to 10-year-old children was shown to be as safe and effective as nitrous oxide in oxygen sedation for extraction of primary teeth but would not be the method of choice for all patients.
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The performance of continuous bilateral sciatic nerve blocks under ultrasonographic control using stimulating catheters is described in a 4-year-old child with VACTERL syndrome. Ultrasound showed an abnormal vascular and nerve supply to the lower limbs. The use of ultrasound guidance made successful continuous sciatic nerve blocks possible in a child in whom the traditional method of nerve localisation was unlikely to succeed for anatomical reasons.
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Acute pulmonary hypertension with life-threatening right heart failure may complicate the postoperative course following cardiothoracic surgery. Both inhaled nitric oxide and inhaled iloprost, a stable analogue of prostacyclin, have been used frequently for this purpose in acute pulmonary hypertension of various origins. We present a case of a patient with acute pulmonary hypertension and severely impaired gas exchange following pulmonary thrombo-endarterectomy. ⋯ Combined inhaled nitric oxide and inhaled iloprost, however, showed additive effects. Hence, the combination of both drugs may be reasonable in cases where the standard therapy fails. The effect has been demonstrated by means of continuous blood gas monitoring.