Anaesthesia
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Randomized Controlled Trial
Subcutaneous naloxone for the prevention of intrathecal morphine induced pruritus in elective Caesarean delivery.
The aim of this study was to assess the antipruritic efficacy of subcutaneous naloxone following intrathecal morphine administration. Fifty women undergoing elective Caesarean section using spinal anaesthesia were randomly allocated, in a double-blind study design, to receive either naloxone 400 microg or placebo as a subcutaneous injection at the end of surgery. Spinal anaesthesia was performed using 0.5% hyperbaric bupivacaine, 25 microg fentanyl and 150 microg of preservative-free morphine sulphate. ⋯ The incidence of pruritus and nausea and vomiting was not significantly different between the two groups. There was also no significant difference in postoperative analgesia between the two groups. We conclude that pruritus, following intrathecal fentanyl 25 microg and preservative-free morphine sulphate 150 microg, is not reduced by the addition of naloxone 400 microg administered subcutaneously on the completion of surgery.
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The clinical features of propofol infusion syndrome (PRIS) are acute refractory bradycardia leading to asystole, in the presence of one or more of the following: metabolic acidosis (base deficit > 10 mmol.l(-1)), rhabdomyolysis, hyperlipidaemia, and enlarged or fatty liver. There is an association between PRIS and propofol infusions at doses higher than 4 mg.kg(-1).h(-1) for greater than 48 h duration. Sixty-one patients with PRIS have been recorded in the literature, with deaths in 20 paediatric and 18 adult patients. ⋯ Predisposing factors include young age, severe critical illness of central nervous system or respiratory origin, exogenous catecholamine or glucocorticoid administration, inadequate carbohydrate intake and subclinical mitochondrial disease. Treatment options are limited. Haemodialysis or haemoperfusion with cardiorespiratory support has been the most successful treatment.
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Ten volunteers evaluated the performance of four currently available manikins: Airway Management Trainer, Airway Trainer, Airsim and Bill 1 as simulators for the 16 procedures described in the Difficult Airway Society Guidelines (DAS techniques) and eight other advanced airway techniques (non-DAS techniques), by scoring and ranking each manikin and procedure. Manikin performance was unequal (p < 0.0001 for both SCORE and RANK data for both DAS and non-DAS techniques). ⋯ The power to discriminate for individual procedures was considerably lower but for 15 of 16 DAS techniques and 6 of 8 non-DAS techniques, manikin performance differed significantly. Post hoc tests showed significant performance differences between individual manikins for 10 DAS procedures, with the Laerdal manikin performing best.
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Comparative Study
Evaluation of four airway training manikins as patient simulators for the insertion of single use laryngeal mask airways.
We evaluated the performance of four manikins: Airsim(trade mark), Bill 1, Airway Management Trainer and Airway Trainer, as simulators for insertion of single-use laryngeal mask airways and the reusable LMA Classic. Sixteen volunteer anaesthetists inserted each laryngeal mask airway into each manikin twice. Insertions were scored for ease of insertion, clinical and fibreoptic position, and lung ventilation (maximum score 10). ⋯ The VBM manikin performed best overall and for several individual laryngeal mask airways. The methodology is useful for future evaluations of devices, both manikins and supraglottic airways. Further human clinical research is required.