Anaesthesia
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Randomized Controlled Trial Comparative Study
A randomised, crossover comparison between the CobraPLA and the LMA Classic in paralysed patients.
We performed a randomised, crossover study in 38 anaesthetised and paralysed patients to compare the performance of the CobraPLA and the LMA Classic during controlled ventilation. The median (IQR [range]) airway leak pressure was 23.0 (20-24 [12-30]) cmH(2)O for the CobraPLA and 15.0 (12-19 [8-30]) cmH(2)O for the LMA Classic (p < 0.001). The median (IQR [range]) insertion time was 15.0 (11-26 [9-31]) s for the CobraPLA and 22.5 (20-25 [15-50]) s for the LMA Classic (p < 0.001). ⋯ There were no adverse events during anaesthesia. The CobraPLA provides a better airway leak pressure and takes less time to insert than the LMA Classic in paralysed patients. Our data show that the CobraPLA can be used to secure a patent airway during controlled ventilation in selected patients.
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Randomized Controlled Trial Comparative Study
A randomised comparison of the single use LMA Flexible with the reusable LMA Flexible in paediatric dental day-case patients.
In this study we compared the performance of the single use flexible laryngeal mask airway (LMA Flexible) with the original reusable LMA Flexible in paediatric dento-alveolar day-case surgery. The aim of the study was to determine whether these two supraglottic airway devices were clinically equivalent when used for simple dental extractions in children under general anaesthesia. This randomised comparative trial in 100 healthy children used first attempt airway insertion success as its primary outcome measure. ⋯ Both devices performed equally well during surgery, with no significant differences in episodes of intra-operative airway compromise (p = 0.387), and both the single use and reusable LMA Flexible displayed excellent recovery characteristics, with no occurrences of emergence airway obstruction. No blood was discovered within the inner LMA tube shaft in either device, implying that both protected against tracheobronchial soiling. We conclude therefore that the single use LMA Flexible is an acceptable alternative to the reusable LMA Flexible.
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Randomized Controlled Trial
M-Entropy guidance vs standard practice during propofol-remifentanil anaesthesia: a randomised controlled trial.
Seventy-two patients undergoing routine surgical procedures under propofol-remifentanil anaesthesia were randomly assigned to receive either standard clinical practice (n = 35) or standard practice plus monitoring of depth of anaesthesia with M-Entropy (n = 37). Patients in the standard practice group received more propofol than the entropy group (mean (SD) 95 (14) vs 81 (22) microg.kg(-1).min(-1), respectively; p < 0.01), and less remifentanil (0.39 (0.08) vs 0.46 (0.08) microg.kg(-1).min(-1), respectively; p < 0.001). ⋯ Both regimens resulted in fast recovery with no clinical advantage for either one. There were no significant differences in haemodynamic parameters, postoperative nausea and vomiting or satisfaction with the procedure.
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Randomized Controlled Trial
Comparison of the incidence and severity of cough induced by sufentanil and fentanyl: a prospective, randomised, double-blind study.
We compared the incidence and severity of cough following a bolus of sufentanil with that following fentanyl in 510 patients, randomly allocated to receive sufentanil 0.3 microg.kg(-1), fentanyl 3 microg.kg(-1) or 5 ml sterile water intravenously over 5 s. Coughing was graded depending on the number of coughs as mild (1-2), moderate (3-5) and severe (> 5). ⋯ Sufentanil was also associated with a lesser severity (p = 0.039) of coughing compared with fentanyl. We conclude that equipotent boluses of sufentanil and fentanyl increase the incidence of cough, although the incidence and severity of coughing with sufentanil are less than those with fentanyl.
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Randomized Controlled Trial
Pre-operative analgesia with rectal diclofenac and/or paracetamol in children undergoing inguinal hernia repair.
Both rectal diclofenac and paracetamol are commonly used to treat acute postoperative pain in children but combining them to improve the quality of analgesia is controversial. This study aimed to detect whether the pre-operative combined administration of rectal diclofenac and paracetamol is superior to either drug alone. One hundred and eight patients were randomly assigned to receive either rectal diclofenac 1 mg.kg(-1) or paracetamol 40 mg.kg(-1) or their combination 1 h prior to surgery. ⋯ If the patients experienced a pain score of 2 or more, morphine was given. The total dose of morphine and number of doses required were recorded. Children who received the rectal diclofenac-paracetamol combination experienced a lower pain scale and a decreased need for morphine compared with children receiving each drug alone.