Anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of the nasal mask and the nasopharyngeal airway in paediatric chair dental anaesthesia.
This study compared the quality of anaesthesia and surgical access afforded by two techniques for the administration of anaesthesia during paediatric chair dental procedures. A total of 50 ASA 1 paediatric day case patients were randomly assigned to receive anaesthesia through either the traditional Goldman nasal mask or through a nasopharyngeal airway. ⋯ Operating conditions were universally graded as excellent in the nasopharyngeal airway group, while those in the nasal mask group were graded as excellent/good in only 79% of cases (p < 0.0001). These results suggest that better quality anaesthesia and operating conditions can be achieved by using a nasopharyngeal airway rather than the traditional nasal mask for the administration of anaesthesia to paediatric chair dental patients.
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Clinical Trial Controlled Clinical Trial
Gastric intramucosal pH and blood lactate in severe sepsis.
We prospectively investigated the effect of conventional resuscitation on gastric intramucosal pH and lactate over 5 days in a group of patients with newly diagnosed severe sepsis. Lactate and gastric intramucosal pH were measured on entry into the study, as soon as resuscitation end points were met, eight hourly for 48 h and daily for 5 days. Sixteen of 18 patients had a low gastric intramucosal pH (mean (SD) 7.17 (0.12)) at the time of diagnosis of severe sepsis. ⋯ At 48 h lactate was lower in survivors (p < 0.01) and gastric intramucosal pH higher in survivors (p < 0.05). Receiver operating characteristic curves at this time indicate that lactate is a better predictor of survival. It is likely, based on the inability of gastric intramucosal pH to distinguish survivors from nonsurvivors until 48 h, that it is not possible to use this measurement to guide resuscitation in patients who are severely ill and who have gastric intramucosal acidosis.
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Despite common clinical opinion that patient-controlled analgesia should be renamed 'patient-controlled nausea', there is little evidence in support of the notion that postoperative nausea and vomiting are exacerbated by the method. Indeed, data indicate that opioid-sparing techniques are not associated with less postoperative nausea and vomiting. Although some evidence suggests that certain opioids are less emetogenic than others, this too does not stand scrutiny when compared across patients, although research is still required to find whether individual patients are better treated with a particular opioid. Similarly, the emerging practice of combining anti-emetics with patient-controlled analgesia needs wider study before it can be supported.
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Randomized Controlled Trial Clinical Trial
Ease of insertion of the laryngeal mask airway by inexperienced personnel when using an introducer.
The Portex introducer for the laryngeal mask airway was designed as an aid to successful insertion, acting as an idealised 'artificial hard palate' to guide the tip of the laryngeal mask into the correct position. A number of authors have investigated laryngeal mask insertion by unskilled personnel in certain situations, one example being nurses during in-hospital cardiopulmonary resuscitation. We investigated whether the introducer had any effect on the incidence of first-time successful LMA placement by unskilled personnel. ⋯ In 44 patients with the LMA being inserted according to the manufacturer's instructions, there was a 68% success rate (14 failures). In 45 patients with the LMA being inserted with the aid of a Portex introducer, there was a 96% success rate (two failures). This was a highly significant improvement (p < 0.001).
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Randomized Controlled Trial Clinical Trial
Detection of accidental oesophageal intubation. Role of the anaesthetic assistant.
Three situations in which an anaesthetic assistant might be able to detect accidental oesophageal intubation during or immediately after intubation were assessed. These were: firstly, whilst applying cricoid pressure, secondly, whilst applying gentle palpation over the trachea just above the suprasternal notch and, thirdly, after intubation by means of a 'roll test'. During cricoid pressure, tracheal intubation was correctly diagnosed in all of 10 cases. ⋯ In the 'roll test', two out of 10 tracheal and five out of 10 oesophageal intubations were misdiagnosed. In conclusion, no method could be relied on entirely and may indeed give false reassurance. Nonetheless, any doubt expressed about the tracheal tube position by the assistant should be taken seriously and a careful check made.