Anaesthesia
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Randomized Controlled Trial Comparative Study
Comparison of work of breathing using drawover and continuous flow anaesthetic breathing systems in children.
We compared the work of breathing under general anaesthesia in children using drawover and continuous flow anaesthetic systems. A pilot study was conducted in four children weighing > 20 kg in whom it would usually be considered appropriate to use breathing systems designed for adult anaesthesia. The pilot study compared work of breathing using the Mapleson D breathing system and the Triservice Anaesthetic Apparatus (TSAA). ⋯ Following completion of the pilot study, we conducted a study on 10 children weighing between 10 and 20 kg comparing work of breathing using the Mapleson F breathing system and the TSAA. We found no significant difference in the work of breathing between the Mapleson F and the TSAA for these children. The TSAA can therefore be recommended for use down to a lower weight limit of 10 kg.
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Randomized Controlled Trial
Postoperative analgesia requirements at home after inguinal hernia repair: effects of wound infiltration on postoperative pain.
The aim of this study was to evaluate our postoperative pain protocol after ambulatory herniorrhaphy and to determine how infiltration with local anaesthetics would add to our management of postoperative pain. Two groups of 60 patients, scheduled for herniorrhaphy, received wound infiltration with 20 ml levobupivacaine 0.5% or saline 0.9%. Postoperatively, the patients regulated their own analgesic consumption and registered VAS scores, use of analgesics and side-effects in a diary for 5 days. ⋯ Most patients used acetaminophen in the first 5 days after surgery and occasionally diclofenac. Only a minority used tramadol. Our multimodal pain protocol achieved reasonable results at rest, but a considerable number of patients experienced moderate to severe pain with movement.
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Randomized Controlled Trial
Internal jugular vein compression to assess the correct placement of an epidural catheter in postpartum women.
We investigated whether the increase in epidural pressure produced by jugular compression could be used as a test for correct placement of epidural catheters in 20 postpartum women who had good epidural analgesia during labour. We measured the epidural pressure by using the epidural catheter as a manometer, and measured the rise in the meniscus in response to jugular vein compression whilst the epidural catheter was still in the epidural space. ⋯ In all subjects, jugular vein compression produced a rise in the meniscus only whilst the catheter tip lay in the epidural space. Jugular compression is a useful test for confirming the correct placement of the epidural catheter.
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Randomized Controlled Trial Comparative Study
Comparison of the single use and reusable intubating laryngeal mask airway.
We compared the times to intubate the trachea using the single use (Group S) and reusable (Group C) intubating laryngeal mask (ILMA(TM)), in 84 healthy patients with normal airways undergoing elective gynaecological surgery. There was no significant difference in the ease of insertion of the ILMA or the tracheal tube, or time to successful insertion (Group S, 101.4 s (SD 63.2) vs Group C, 90.4 s (SD 46.1), p = 0.366). The ILMA was successfully inserted on first attempt in 63% of Group S patients and in 68% of Group C patients. ⋯ There was a failure to insert the ILMA in two patients in each group. There was no difference in side-effects (desaturation S(p)o(2) < 95%, bleeding, oesophageal intubation, lip, dental or mucosal injury, or sore throat postoperatively). We conclude that the disposable ILMA is an acceptable alternative to the reusable ILMA.