British journal of anaesthesia
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Randomized Controlled Trial Multicenter Study Clinical Trial
Transfusion requirements in critical care (TRICC): a multicentre, randomized, controlled clinical study. Transfusion Requirements in Critical Care Investigators and the Canadian Critical care Trials Group.
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Randomized Controlled Trial Comparative Study Clinical Trial
Topical anaesthesia of intact skin: liposome-encapsulated tetracaine vs EMLA.
In this randomized, double-blind study, we have compared the ability of 5% liposome-encapsulated tetracaine (amethocaine) (LET) vs 5% eutectic mixture of local anaesthetics (EMLA) to produce local anaesthesia of intact skin in 40 healthy volunteers. Volunteers had both preparations applied to their forearms under an occlusive dressing for 1 h. Superficial anaesthesia was measured by a total of nine 1-mm pinpricks on each arm. ⋯ In volunteers who had deeper anaesthesia assessed, there was no significant difference (P = 0.065) in VAS scores for LET (mean 1.5 (SD 1.4); n = 34) vs EMLA (2.4 (2.1); n = 28). Overall anaesthetic effect, as ranked by all of the subjects, was significantly better for LET compared with EMLA (P = 0.024). We have demonstrated that when applied in equal volumes, 5% LET produced better superficial local anaesthesia than EMLA.
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A 63-yr-old woman was anaesthetized for sub-total thyroidectomy. The thyroid gland was large, deviating the trachea to the right and causing 30% tracheal narrowing at the level of the suprasternal notch. Mask ventilation was easy but laryngoscopy was Cormack and Lehane grade 3. ⋯ An intubating laryngeal mask was inserted and although the airway was clear and ventilation easy, it was not possible to intubate the trachea either blindly or with the fibreoptic bronchoscope. Tracheal intubation was eventually achieved using a 6.5-mm cuffed oral tracheal tube via a size 4 laryngeal mask under fibreoptic control. We describe the case in detail and discuss the use of the intubating laryngeal mask, its potential limitations and how to optimize its use in similar circumstances.
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It is known that volatile anaesthetics protect myocardial tissue against ischaemic and reperfusion injury in vitro. In this investigation, we have determined the effects of the inhalation anaesthetics, enflurane, isoflurane, sevoflurane and desflurane, administered only during early reperfusion, on myocardial reperfusion injury in vivo. Fifty chloralose-anaesthetized rabbits were subjected to 30 min of occlusion of a major coronary artery followed by 120 min of reperfusion. ⋯ The results show that desflurane and sevoflurane markedly reduced infarct size and therefore can protect myocardium against reperfusion injury in vivo. Enflurane had only a marginal effect and isoflurane offered no protection against reperfusion injury in vivo. These different effects suggest different protective mechanisms at the cellular level.