Anaesthesia
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Haemodynamic instability is a recognised phenomenon in critically ill patients undergoing hyperbaric therapy. Instability may result from the effects of ambient pressure on the cardiovascular system, devices involved in infusion of drugs and fluids, or a combination of the two. The effect of hyperbaric pressure on air-containing spaces in syringes has not been previously measured. ⋯ There was compression of air spaces within the syringe causing retrograde flow of fluid within the low volume extension set. The mean (95% CI) change in volume was 154 (141-168) microl at 2.4 ATA, and 197 (183-212) microl at 2.8 ATA (both p < 0.0001). We conclude that hyperbaric exposure may cause clinically significant changes in syringe function at infusion rates < 100 ml. h(-1).
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We wished to investigate whether intensive care represents good value for money to the National Health Service in the UK using cost-effectiveness analysis. We developed a cost-effectiveness model using secondary data sources to estimate the incremental cost per quality adjusted life year gained of treatment in intensive care vs non-intensive care treatment in adults. Estimates of hospital mortality with and without intensive care were obtained from seven published studies and from data published by the Intensive Care National Audit and Research Centre. ⋯ This figure is sensitive to the mortality risk reduction associated with intensive care. Despite the high daily cost of intensive care, its cost-effectiveness is excellent and compares favourably with other commonly used health interventions. Our findings suggest that adult intensive care represents good value for money.
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Randomized Controlled Trial Comparative Study
Bilateral intra-oral, infra-orbital nerve block for postoperative analgesia following cleft lip repair in paediatric patients: comparison of bupivacaine vs bupivacaine-pethidine combination.
This prospective, randomised, double blind study compared the efficacy of pethidine as an adjuvant to bupivacaine with the efficacy of bupivacaine alone for infra-orbital nerve block in alleviating postoperative pain in children undergoing cleft lip repair. Forty paediatric patients aged between 5 and 60 months undergoing cleft lip repair were randomly allocated to two groups of 20. ⋯ The median (IQR) duration of analgesia from the time of administration of block in group B was 18 h (14.2-20) compared to 29.1 h (24-36) in group P (p = 0.001). Addition of pethidine as an adjunct to local anaesthetic significantly prolonged the duration of postoperative analgesia without any adverse effects.
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Randomized Controlled Trial Comparative Study
Comparison of the analgesic efficacy and respiratory effects of morphine, tramadol and codeine after craniotomy.
Pain after craniotomy remains a significant problem. The effect of morphine and tramadol patient-controlled analgesia (PCA) on arterial carbon dioxide tension is unknown in patients having such surgery. Sixty craniotomy patients were randomly allocated to receive morphine PCA, tramadol PCA or codeine phosphate 60 mg intramuscularly. ⋯ Morphine produced significantly better analgesia than tramadol at all time points (p < 0.005) and better analgesia than codeine at 4, 12 and 18 h. Patients were more satisfied with morphine than with codeine or tramadol (p < 0.001). Vomiting and retching occurred in 50% of patients with tramadol, compared with 20% with morphine and 29% with codeine.