Anaesthesia
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Randomized Controlled Trial
Epidural infusion of levobupivacaine and sufentanil following thoracotomy.
A prospective, randomised, double-blind study was conducted to compare the efficacy of two doses of levobupivacaine combined with sufentanil for continuous epidural infusion following thoractomy. A total of 72 patients undergoing lobectomy or pneumonectomy were enrolled. An epidural catheter was inserted between the levels of T4 and T6 before induction of anaesthesia and a loading dose of levobupivacaine and sufentanil was administered. ⋯ Visual analogue pain scores after coughing (VASi) were always higher in group B (p < 0.05); VAS pain scores at rest were higher for the first 4 h and at 16 and 28 h in group B (p < 0.05). Total morphine consumption and requests number was lower in group A (p < 0.05). Better pain relief was achieved using epidural 0.125% levobupivacaine.
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Randomized Controlled Trial Comparative Study
Comparison of cricothyroidotomy on manikin vs. simulator: a randomised cross-over study.
We compared the time taken to perform cricothyroidotomy on a manikin to that on a medium fidelity simulator, to assess the effect of psychological stress and time pressure on performance. Seventy anaesthetists participated in this randomised cross-over study. ⋯ Anaesthetists with more experience performed the procedure more quickly on both manikin and simulator. We conclude that psychological stress and time pressure in real-life scenarios can affect the performance of cricothyroidotomy.
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Randomized Controlled Trial Comparative Study
Cervical spine movement during laryngoscopy using the Airway Scope compared with the Macintosh laryngoscope.
The Airway Scope is a new rigid laryngoscope. This intubation device provides a non-line-of sight view of the glottis. A non-line-of sight view is expected to cause less movement of the cervical spine during laryngeal visualisation. ⋯ Cervical spine movement during laryngoscopy with the Airway Scope was 37%, 37% and 68% less than that with the Macintosh laryngoscope at the C0/C1, C1/C2 and C3/C4 motion segments, respectively (p < 0.05). The movement of the atlanto-occipital distance using the Airway Scope was 42% less than that during laryngoscopy using the Macintosh laryngoscope (p < 0.05). Laryngoscopy using the Airway Scope involves less movement of the cervical spine compared to conventional laryngoscopy using the Macintosh laryngoscope.
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Randomized Controlled Trial Comparative Study
The pharmacokinetics of ropivacaine after four different techniques of brachial plexus blockade.
Arterial plasma concentrations of ropivacaine were measured after brachial plexus blockade using four different approaches: lateral interscalene (Winnie), posterior interscalene (Pippa), axillary and vertical infraclavicular. Four groups of 10 patients were given a single 3.75 mg.kg(-1) injection of ropivacaine 7.5 mgxml(-1). ⋯ More ropivacaine is taken up by the systemic circulation in the first hour after the supraclavicular approaches; the mean (SD) area under the concentration-time curve was larger: 2.63 (0.51) microgxml(-1).h vs 2.10 (0.49) microgxml(-1).h (p = 0.002). These results show that the technique used for brachial plexus blockade significantly influences the systemic uptake of ropivacaine.
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Randomized Controlled Trial
Effects of albumin 5% and artificial colloids on clot formation in small infants.
Albumin is often cited in textbooks as the gold standard for fluid replacement in paediatrics, but in practice artificial colloids are more frequently used. Although one concern with the use of artificial colloids is their intrinsic action on haemostasis, the available data in children are inconclusive for 6% hydroxyethyl starch 130/0.4 (HES) and no data exist for gelatine solution with respect to coagulation. A total of 42 children (3-15 kg) undergoing surgery and needing colloid replacement were randomly assigned to receive 15 mlxkg(-1) of either albumin 5%, 4% modified gelatine solution or 6% hydroxyethyl starch 130/0.4 solution. ⋯ After gelatine and after albumin the median clot firmness decreased significantly but remained within the normal range. Following HES, coagulation time increased significantly, and clot formation time, alpha angle, clot firmness, and fibrinogen/fibrin polymerisation were significantly more impaired than for albumin or gelatine, reaching median values below the normal range. From a haemostatic point of view it might be preferable to use gelatine solution as an alternative to albumin; HES showed the greatest effects on the overall coagulation process.