Anaesthesia
-
We assessed the minimal remifentanil dosage required for tracheal tube tolerance in awake and spontaneously breathing patients after major abdominal surgery. Forty postoperative patients received remifentanil 0.1 microg.kg(-1).min(-1), which was reduced in steps of 0.025 microg.kg(-1).min(-1) every 30 min. Respiratory response subscore of comfort scale (CSRR), Ramsay sedation scale (RSS), visual analogue scale (VAS), respiratory rate, and minute ventilation were recorded. ⋯ Thirty-one patients (77.5%) reached a CSRR 2 and RSS 2 with remifentanil 0.025 microg.kg(-1).min(-1) and nine patients (22.5%) required remifentanil 0.05 microg.kg(-1).min(-1). Analgesia was sufficient in all patients (VAS = 30). Remifentanil 0.025-0.05 microg.kg(-1).min(-1) achieves satisfactory tracheal tube tolerance in awake and spontaneously breathing patients.
-
Anaesthetists rely upon a loss of resistance and flow of cerebrospinal fluid to indicate when a spinal needle has breached the dura. The loss of resistance is not always felt, with the danger that the needle may be advanced into neurological tissue. One hundred women undergoing elective caesarean section were recruited and spinal anaesthesia, using a 27-G Whitacre needle, was performed using an incremental advancement technique. ⋯ Six patients were not included in the study due to technical difficulties. In 27 of 94 patients (29%) there was no clear tactile sign that the dura had been breached when cerebrospinal fluid was obtained. This study demonstrates that loss of resistance is not always felt when a 27-G spinal needle breaches the dura in the pregnant woman.
-
Intra-operative awareness in paediatric patients has been little studied for many years because of the difficulties in relying on children's testimony. Earlier questionnaires used to detect this complication were not adapted to children's language and memory capacities. By using a qualitative method, a semi-structured in-depth interview adapted to their cognitive abilities, we have now conducted a prospective evaluation of the incidence and risk factors for intra-operative awareness in children undergoing general anaesthesia. ⋯ The only predictive factor identified was the multiple manoeuvres with which the airways were secured (odds ratio, 8.4; 95% confidence interval, 2.4-29.07%). The present study confirms the existence of intra-operative awareness in the paediatric population. The application of a semi-structured in-depth interview adapted to the cognitive capacities of the children appears to enhance the detection of awareness in this population.