Anaesthesia
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Randomized Controlled Trial Clinical Trial
The effect of epidural opioids on maternal oxygenation during labour and delivery.
The effects of epidural fentanyl on the incidence of maternal hypoxaemia during labour and on neonatal welfare were examined. Women were randomly allocated to receive one of two epidural infusions, bupivacaine 0.125% alone or bupivacaine 0.0625% with 2.5 micrograms.ml-1 fentanyl, and maternal arterial oxygen saturation was monitored continuously until delivery. ⋯ Similarly, the incidence of desaturation to SpO2 < or = 90% was greater in the fentanyl group than in controls (p = 0.02). There was no correlation between maternal oxygenation or plasma fentanyl concentration and neonatal welfare as measured by umbilical arterial and venous blood gas and acid base status, Apgar score and Neurologic and Adaptive Capacity Score.
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Comparative Study Clinical Trial Controlled Clinical Trial
A comparison of the forces exerted during laryngoscopy. The Macintosh versus the McCoy blade.
The forces exerted at laryngoscopy with the McCoy and Macintosh blades have been compared in 40 patients. The variables measured were the duration of laryngoscopy, the three maximally-applied forces and the mean force. ⋯ It is concluded that the use of the McCoy blade results in significantly less force being applied during laryngoscopy. This may be the reason for the reduction in the stress response reported previously with the use of the McCoy blade.
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Randomized Controlled Trial Comparative Study Clinical Trial
Simulated difficult intubation. Comparison of the gum elastic bougie and the stylet.
A randomised study was carried out to compare the efficacy of the gum elastic bougie and the stylet in a simulated difficult intubation. A laryngoscopic assessment, as described by Cormack and Lehane, was made in 100 patients. A Grade 3 view was then simulated. ⋯ In the Stylet First Group (50 patients) the order was reversed. After two attempts the tube was correctly placed in the trachea in 96% of cases in the Bougie First Group compared to only 66% of cases in the Stylet First Group (p < 0.001). We recommend that a gum elastic bougie should be readily available and that anaesthetists should use it in preference to a stylet whenever a good view of the glottis is not immediately available.
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Randomized Controlled Trial Clinical Trial
Lack of efficacy of intra-articular opioids for analgesia after day-case arthroscopy.
A randomised double-blind placebo-controlled trial was undertaken to assess the analgesic efficacy of intra-articular opioids following arthroscopy of the knee. At the completion of surgery, patients received an intra-articular injection of: morphine 1 mg, buprenorphine 30 micrograms or 0.9% saline. There were no differences in pain scores among groups for the first 24 h postoperatively. We have found no clinical evidence for a peripherally-mediated opioid analgesic effect.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison between the Macintosh and the McCoy laryngoscope blades.
The view of the larynx using the Macintosh laryngoscope and the McCoy levering laryngoscope was assessed in 177 adult patients. The view with the McCoy blade in the neutral position and in the position (neutral or elevated) that gave the 'best' view were recorded. The McCoy blade in the neutral position was associated with a lower incidence of grade 1 views and a higher incidence of grade 2 views than the Macintosh blade. ⋯ In 25 patients, the vocal cords could not be seen with the Macintosh blade; in these patients the view was better with the McCoy blade (the cords were visible) on 14 occasions and worse in one (p = 0.001). We conclude that the McCoy blade in its neutral position does not behave identically to the Macintosh blade. The McCoy blade is a useful aid to difficult intubation but should not replace the Macintosh blade as the first choice laryngoscope.