Anaesthesia
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Randomized Controlled Trial Comparative Study
A randomised single blinded study of the administration of pre-warmed fluid vs active fluid warming on the incidence of peri-operative hypothermia in short surgical procedures.
We compared the effect of delivering fluid warmed using two methods in 76 adult patients having short duration surgery. All patients received a litre of crystalloid delivered either at room temperature, warmed using an in-line warming device or pre-warmed in a warming cabinet for at least 8 h. ⋯ The administration of 1 l warmed fluid to patients having short duration general anaesthesia results in higher postoperative temperatures. Pre-warmed fluid, administered within 30 min of its removal from a warming cabinet, is as efficient at preventing peri-operative hypothermia as that delivered through an in-line warming system.
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Randomized Controlled Trial
Potency and recovery characteristics of rocuronium mixed with sodium bicarbonate.
Sodium bicarbonate may be added to rocuronium to decrease pain on injection. However, this mixture may result in the formation of carbon dioxide bubbles. We investigated whether the addition of sodium bicarbonate to rocuronium alters neuromuscular blockade, in 120 patients randomly assigned to receive rocuronium mixed with saline or bicarbonate 8.4%, either in varying doses (for dose-response measurements; 60 patients) or a fixed dose of 600 μg.kg(-1) (for time-course measurements; 60 patients). ⋯ The mean (SD) onset times of rocuronium 600 μg.kg(-1) were 3.6 (0.6) and 2.7 (0.5) min in the corresponding groups, respectively (p < 0.001). The mean (SD) times to 95% recovery were 35.8 (5.8) and 47.9 (7.1) min, respectively (p < 0.001). We conclude that the mixing of sodium bicarbonate with rocuronium enhances the potency, shortens the onset and prolongs the duration of action.
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Randomized Controlled Trial Comparative Study
Comparison of guided insertion of the LMA ProSeal vs the i-gel.
In a randomised, non-crossover study, we tested the hypothesis that the ease of insertion using a duodenal tube guided insertion technique and the oropharyngeal leak pressure differ between the LMA ProSeal and the i-gel in non-paralysed, anesthetised female subjects. One hundred and fifty-two females aged 19-70 years were studied. Insertion success rate, insertion time and oropharyngeal leak pressure were measured. ⋯ Mean (SD) insertion times were similar (LMA ProSeal, 40 (16) s; i-gel 43 (21) s). Mean oropharyngeal leak pressure was 7 cmH(2) O higher with the LMA ProSeal (p < 0.0001). Insertion of the LMA ProSeal and i-gel is similarly easy using a duodenal tube guided technique, but the LMA ProSeal forms a more effective seal for ventilation.
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Randomized Controlled Trial
Optimal timing for the administration of intranasal dexmedetomidine for premedication in children.
Previous studies have shown that 1 μg.kg(-1) intranasal dexmedetomidine produces significant sedation in children aged between 2 and 12 years. This investigation was designed to evaluate the onset time. One hundred children aged 1-12 years of ASA physical status 1-2 undergoing elective surgery were randomly allocated to five groups. ⋯ Overall 62% of the children who received intranasal dexmedetomidine had satisfactory sedation at the time of cannulation. The median (95% CI) time for onset of sedation was 25 (25-30) min. The median (95% CI) duration of sedation was 85 (55-100) min.
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We investigated the cross-sectional area of the femoral vein and its relationship to the femoral artery at two anatomical levels, in infants and children. Sixty-six subjects were allocated to one of two groups: infants (< 1 year, n = 31) or children (1-6 years, n = 35). ⋯ Hip rotation with 60° leg abduction decreased femoral artery overlap at the level of the inguinal crease in both infants (p = 0.013) and children (p = 0.003). Thus, the optimal place for femoral vein cannulation in paediatric patients seems to be at the level of the inguinal crease with 60° leg abduction and external hip rotation.