Anaesthesia
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Review
Decision analysis in anaesthesia: a tool for developing and analysing clinical management plans.
Traditional medical decision making is unstructured and incorporates evidence haphazardly. I present a more structured approach based on decision analysis, a model that considers all relevant options and outcomes informed by evidence where appropriate. This method is useful both for planning clinical management and for analysing decisions already taken.
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Randomized Controlled Trial Comparative Study
Paraesthesia during the needle-through-needle and the double segment technique for combined spinal epidural anaesthesia.
Paraesthesia during regional anaesthesia is an unpleasant sensation for patients and, more importantly, in some cases it is related to neurological injury. Relatively few studies have been conducted on the frequency of paraesthesia during combined spinal epidural anaesthesia. We compared two combined spinal epidural anaesthesia techniques: the needle-through-needle technique and the double segment technique in this respect. ⋯ Both techniques were performed using a 27G pencil point needle, an 18G Tuohy needle, and a 20G multiport epidural catheter from the same manufacturer. The overall frequency of paraesthesia was higher in the needle-through-needle technique group (56.9% vs. 31.6%, p = 0.011). The frequency of paraesthesia at spinal needle insertion was 20.7% in the needle-through-needle technique group and 8.8% in the double segment technique group; whereas the frequency of paraesthesia at epidural catheter insertion was 46.6% in the needle-through-needle technique group and 24.6% in the double segment technique group.
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Randomized Controlled Trial Multicenter Study
Does the efficacy of supplemental oxygen for the prevention of postoperative nausea and vomiting depend on the measured outcome, observational period or site of surgery?
High intra-operative oxygen concentration reportedly reduces postoperative nausea and vomiting (PONV), but recent data are conflicting. Therefore, we tested whether the effectiveness of supplemental oxygen depends on the endpoint (nausea vs. vomiting), observation interval (early vs. late) or surgical field (abdominal vs. non-abdominal). We randomly assigned 560 adult patients undergoing various elective procedures with a PONV risk of at least 40% to intra-operative 80% (supplemental) or 30% oxygen (control). ⋯ Incidences of nausea were similar in the groups during early (12% (supplemental) vs. 10% (control), p = 0.43) and late intervals, 26%vs. 20%, p = 0.09, as were the incidences of vomiting (early: 2%vs. 3%, p = 0.40; late: 8%vs. 9%, p = 0.75). Supplemental oxygen was no more effective at reducing PONV in abdominal (40%vs. 31%, p = 0.37) than in non-abdominal surgery (25%vs. 21%, p = 0.368). Thus, supplemental oxygen was unable to reduce PONV independent of the endpoint, observational period or site of surgery.
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Comparative Study
Comparison of the Berman Intubating Airway and the Williams Airway Intubator for fibreoptic orotracheal intubation in anaesthetised patients.
Sixty patients with no clinical indicators of a difficult airway were selected to undergo a fibreoptic assessment after induction of general anaesthesia using both the Berman Intubating Airway and the Williams Airway Intubator. The bronchoscopic view and ease of railroading a tracheal tube during fibreoptic orotracheal intubation were studied. ⋯ The estimated odds ratio of obtaining an obstructed path was 3.06 times higher for the Berman than the Williams Airway. However, if the glottis could be reached with the bronchoscope, there was no significant difference in the degree of ease of intubation between the two airways.