Anaesthesia
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
A comparison of the induction characteristics of sevoflurane and halothane in children.
The induction characteristics of sevoflurane and halothane were compared in 81 children aged 6 months to 6 years. The mean time taken to achieve loss of eyelash reflex was significantly shorter with sevoflurane than with halothane (sevoflurane, mean time (SD) 1 min 41 s (35 s), halothane, mean time (SD) 2 min 17 s (43 s), t = 4.11, p = < 0.01). ⋯ Effects on heart rate, blood pressure and oxygen saturation during induction were similar for both agents. There were no major complications during induction with either halothane or sevoflurane.
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Randomized Controlled Trial Clinical Trial Controlled Clinical Trial
The delivery of oxygen by a venturi T piece.
We have evaluated the performance of the Intersurgical 40% Oxygen Recovery T-Kit in ten healthy volunteers. Inspired oxygen and end-tidal carbon dioxide concentrations were measured during normal respiration and with variations in respiratory rate and depth. ⋯ All three modifications increased the inspired oxygen concentration, the longer expiratory limb to 34.6% (p < 0.01) and the altered T piece arrangement to 37.3% (p < 0.01). The highest inspired oxygen concentration of 40.3% (p < 0.01) was obtained by increasing the length of the inspiratory limb.
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Randomized Controlled Trial Clinical Trial
Analgesia for day surgery. Evaluation of the effect of diclofenac given before or after surgery with or without bupivacaine infiltration.
One hundred patients undergoing breast lump excision using a standard anaesthetic technique in the Day Care Unit were randomly divided into five groups. Groups A and B received either saline or diclofenac in a double-blind fashion before and at the end of the procedure, with both groups receiving 10 ml of 0.5% bupivacaine infiltration at the end. Groups C and D also received saline or diclofenac before and after surgery but had no bupivacaine infiltration at the end. ⋯ Although not significant (p = 0.22), fewer patients required rescue medication when diclofenac was given before surgery (10%) rather than after surgery (22.5%). Fewer patients had a fair amount or a great deal of pain in the 48 h following surgery when diclofenac was injected before (7.5%) rather than after surgery (12.5%). The mean number of oral analgesics taken in the 48 h after surgery was also lower in those patients who had the diclofenac before the surgery rather than after.
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Surveys conducted in the United Kingdom over the last few years have revealed decreased job satisfaction and increased anxiety and depression in both hospital specialists and general practitioners. Anaesthesia is perceived to be a stressful specialty and there is evidence, albeit patchy, that certain stress-associated conditions are more common in anaesthetists. The 'middle years' seem to be a danger period. ⋯ While outcome studies are numerous much less attention has been paid to the structure and process of anaesthetic practice. Models for studying these aspects have been developed for investigating stress in general practitioners and doctors in training. Even minor degrees of professional impairment may place patients at risk and an investigation into the effects of the specialty on those who practise it is justified.
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Cardioversion is a minor procedure requiring sedation and analgesia. However, it is often performed out-of-hours in remote sites by inexperienced anaesthetists. An understanding is required both of the pathophysiology underlying cardiac arrhythmias and of the technical side of defibrillation equipment, including electrical safety. ⋯ The anaesthetic agent chosen for patients undergoing cardioversion must provide analgesia and sedation, cause the least cardiovascular compromise possible and still enable rapid recovery. Propofol may be the closest anaesthetic agent to this ideal currently available, although careful titration of any agent chosen is also important. Cardioversion may be performed as an emergency, including in the pregnant patient, providing safe anaesthetic practice is followed.