Anaesthesia
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Randomized Controlled Trial
Epidural volume extension in combined spinal epidural anaesthesia for elective caesarean section: a randomised controlled trial.
We investigated the effect of epidural volume extension on spinal blockade in pregnant women undergoing elective caesarean section with a combined spinal-epidural technique. We randomly allocated 90 healthy subjects to three groups to receive spinal hyperbaric bupivacaine 7.5 mg (group B7.5), spinal hyperbaric bupivacaine 7.5 mg immediately followed by epidural volume extension with saline 5 ml (group B7.5-EVE) or spinal hyperbaric bupivacaine 10 mg without epidural volume extension (group B10). ⋯ The overall sensory block level increased with time (p < 0.001), regardless of the group studied, and there were significantly fewer failures of block in the group B10 compared with both B7.5 and B7.5-EVE groups (p = 0.001). In conclusion, we could not demonstrate a benefit in using epidural volume extension with 5 ml saline as part of a combined spinal epidural technique in term parturients undergoing elective caesarean section.
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We report the first description of ultrasound-guided spinal accessory nerve blockade using single-shot and subsequently continuous infusion (via a perineural catheter) local anaesthetic techniques, for the diagnosis and treatment of myofascial pain affecting the trapezius muscle. A 38-year-old man presented with a two-year history of incapacitating left suprascapular pain after a fall onto his outstretched hand. The history and clinical examination was suggestive of myofascial pain affecting the trapezius muscle. ⋯ Following identification of the spinal accessory nerve in the posterior triangle of the neck, we performed ultrasound-guided nerve blocks, first using a single injection of local anaesthetic and subsequently using a continuous infusion via a perineural catheter, to block the nerve and temporarily relieve the patient's pain. We have demonstrated that the spinal accessory nerve is identifiable in the posterior triangle of the neck and can be blocked successfully using ultrasound guidance. This technique can aid the diagnosis and treatment of myofascial pain originating from the trapezius muscle.
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The aim of this study was to determine whether measurement of pre-operative brain natriuretic peptide can significantly improve risk stratification of vascular surgical patients. The study endpoint was postoperative raised troponins. Net reclassification improvement was determined for risk categories based on the Revised Cardiac Risk Index. ⋯ Reclassification based on the optimal discriminatory point significantly improved risk stratification (net reclassification improvement 38.3% (95% CI 9.3-67.3%), p = 0.01 for the entire cohort and 70.3% (95% CI 27.1-113.6%), p = 0.002 for intermediate risk patients). The brain natriuretic peptide tertiles only improved stratification of intermediate risk patients (net reclassification improvement 50.0% (95% CI 16.7-83.3%), p = 0.01). We have shown that measurement of pre-operative brain natriuretic peptide is relevant in the context of risk assessment in this cohort of patients.
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Clinical Trial
Remifentanil as single agent to facilitate awake fibreoptic intubation in the absence of premedication.
Remifentanil is increasingly being used as the primary agent to provide sedation during awake fibreoptic nasal intubation. In this observational study, we aimed to determine the optimal effect site concentration of remifentanil, using a target controlled infusion based on the Minto pharmacological model, to provide optimal safe intubation conditions without the use of other sedatives/premedication and/or spray-as-you-go local anaesthesia. ⋯ No serious adverse event occurred during any of these procedures. These preliminary findings suggest that this is a feasible and safe technique for awake fibreoptic nasal intubation.