Anaesthesia
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Randomized Controlled Trial
A randomised controlled trial of radial artery cannulation guided by Doppler vs palpation vs ultrasound.
We randomly allocated 749 participants to radial artery cannulation by anaesthetic trainees, guided by Doppler (244), palpation (256) or ultrasound (249). Ultrasound increased the rate of cannulation at the first attempt by 14% (95% CI 5-22%), from 39% with Doppler or palpation, p = 0.002 for both. There were no differences in the rates of cannulation 5 min after the procedure started: 147/244 (60%) with Doppler; 160/256 (63%) with palpation; and 171/249 (69%) with ultrasound, p = 0.13.
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Epidural blood patch is the gold standard treatment for post-dural puncture headache, although hydroxyethyl starch may be a useful alternative to blood if the latter is contraindicated. The aim of this experimental study was to assess whether hydroxyethyl starch given via an indwelling intrathecal catheter resulted in clinical or histopathological changes suggestive of neurotoxicity. The study was conducted in rats that were randomly allocated to receive three 10-μl injections on consecutive days of either saline or hydroxyethyl starch administered via the intrathecal catheter. ⋯ No clinical or actimetric changes were observed in either group following intrathecal saline or hydroxyethyl starch administration. Histopathological examination showed non-specific changes with no differences between the two groups. This experimental study in the rat suggests that repeated intrathecal injection of hydroxyethyl starch is not associated with neurotoxicity.