Anaesthesia
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Randomized Controlled Trial
Low-dose desmopressin improves hypothermia-induced impairment of primary haemostasis in healthy volunteers.
Mild hypothermia (34-35 °C) increases peri-operative blood loss. We have previously demonstrated the beneficial effect of in vitro desmopressin on impairment of primary haemostasis associated with hypothermia. This study evaluated subcutaneous desmopressin in 52 healthy volunteers, randomly assigned to receive either normal saline or desmopressin 1.5, 5 or 15 μg (with 13 in each group). ⋯ Hypothermia at 32 °C prolonged mean (95% CI) closure times (for adenosine diphosphate/collagen by 11.3% (7.5-15.2%) and for adrenaline/collagen by 16.2% (11.3-21.2%); these changes were reversed by desmopressin. A very small dose was found to be effective (1.5 μg); this dose did not significantly change closure times at 37 °C, but fully prevented its prolongation at 32 °C. Subcutaneous desmopressin prevents the development of hypothermia-induced impairment of primary haemostasis.
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Randomized Controlled Trial
Postoperative respiratory and analgesic effects of dexmedetomidine or morphine for adenotonsillectomy in children with obstructive sleep apnoea.
The postoperative respiratory and analgesic effects of dexmedetomidine and morphine have not been compared in children with sleep apnoea having adenotonsillectomy. In a randomised double-blind study we recruited 60 children, aged 2-13 years, who received either intravenous dexmedetomidine 1 μg.kg(-1) or morphine 100 μg.kg(-1) on anaesthetic induction. End-tidal carbon dioxide, Children's Hospital of Eastern Ontario Pain Scale score and supplementary morphine administration were recorded every 15 min for 60 min postoperatively. ⋯ Mean (SD) pain scores were higher with dexmedetomidine (8.1 (2.0) immediately postoperatively and 6.7 (1.0) at 60 min vs 7.6 (1.8) and 6.3 (0.7), respectively, with morphine (p = 0.023)). More patients required supplementary morphine with dexmedetomidine (13/30 (43%) vs 21/30 (70%); p = 0.037). Postoperatively, dexmedetomidine produced less respiratory depression than morphine, but less effective analgesia.
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Head injury is one of the major causes of trauma-related morbidity and mortality in all age groups in the United Kingdom, and anaesthetists encounter this problem in many areas of their work. Despite a better understanding of the pathophysiological processes following traumatic brain injury and a wealth of research, there is currently no specific treatment. Outcome remains dependant on basic clinical care: management of the patient's airway with particular attention to preventing hypoxia; avoidance of the extremes of lung ventilation; and the maintenance of adequate cerebral perfusion, in an attempt to avoid exacerbating any secondary injury. ⋯ Within critical care, the importance of controlling blood glucose is becoming clearer, along with the potential beneficial effects of hyperoxia. The major improvement in outcome reflects the use of protocols to guide resuscitation, investigation and treatment and the role of specialist neurosciences centres in caring for these patients. Finally, certain groups are now recognised as being at greater risk, in particular the elderly, anticoagulated patient.
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Randomized Controlled Trial
Insertion of six different supraglottic airway devices whilst wearing chemical, biological, radiation, nuclear-personal protective equipment: a manikin study.
Six different supraglottic airway devices: Combitube™, laryngeal mask airway, intubating laryngeal mask airway (Fastrach™), i-gel™, Laryngeal Tube™ and Pro-Seal™ laryngeal mask airway were assessed by 58 paramedic students for speed and ease of insertion in a manikin, whilst wearing either chemical, biological, radiation, nuclear-personal protective equipment (CBRN-PPE) or a standard uniform. All devices took significantly longer to insert when wearing CBRN-PPE compared with standard uniform (p < 0.001). ⋯ Whilst wearing CBRN-PPE the i-gel was the fastest device to insert with a mean (SD (95% CI)) insertion time of 19 (8 (17-21))s, p < 0.001, with the Combitube the slowest with mean (65 (23 (59-71))s. Wearing of CBRN-PPE has a negative impact on supraglottic airway insertion time.