British journal of anaesthesia
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A new design of tracheal tube cuff was compared with two types of high-volume, low-pressure (HVLP) cuffed tracheal tube for leakage of fluid from the subglottic space into the trachea. Spontaneous and positive-pressure ventilation were simulated using a mechanical lung, an intubated model trachea and a ventilator. Excised human tracheas were intubated and leakage past the cuff assessed. ⋯ The new design completely prevented leakage in the model during all modes of ventilation, during tracheal suctioning, and with tube movement. The new cuff also prevented leakage in the excised human tracheas. Tracheal wall distention and tracheal wall pressures were similar for all cuffs tested.
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Randomized Controlled Trial Comparative Study Clinical Trial
Patient-maintained analgesia with target-controlled alfentanil infusion after cardiac surgery: a comparison with morphine PCA.
The performance of a patient-demand, target-controlled alfentanil infusion system was compared with that of a traditional morphine patient-controlled analgesia (PCA) pump in 120 adult patients after cardiac surgery. Patients were randomized to one of the two PCA systems for their postoperative analgesia in the intensive care unit and pain, nausea and sedation scores were recorded every 4 h for the first 24 h. ⋯ In patients using the alfentanil system the overall median visual analogue pain score was 2.3 (95% Cl 2.3-2.8) compared with 3.0 (95% Cl 2.7-3.2) in those using morphine PCA (P < 0.05), but both systems delivered high-quality analgesia. The two groups did not differ with respect to the overall sedation scores, the frequency of postoperative nausea and vomiting, haemodynamic instability, myocardial ischaemia or hypoxaemia.
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Randomized Controlled Trial Clinical Trial
Granisetron in the prevention of nausea and vomiting after middle-ear surgery: a dose-ranging study.
This study was undertaken to determine the minimum effective dose of granisetron, a selective 5-hydroxytryptamine type 3 receptor antagonist, for the prevention of postoperative nausea and vomiting (PONV) after middle-ear surgery. In a randomized, double-blind, placebo-controlled trial, 120 women (ASA I) received placebo (saline) or granisetron at three different doses (20 micrograms kg-1, 40 micrograms kg-1, 100 micrograms kg-1) i.v. immediately before the induction of anaesthesia (n = 30 for each group). ⋯ A complete response, defined as no PONV and no need for another rescue antiemetic during 0-3 h after anaesthesia, occurred in 40%, 43%, 83% and 87% of patients who had received placebo, granisetron 20 micrograms kg-1, granisetron 40 micrograms kg-1 or granisetron 100 micrograms kg-1, respectively; the corresponding incidence during 3-21 h after anaesthesia was 47%, 47%, 87% and 87% (P < 0.05; overall Fisher's exact probability test). Granisetron 40 micrograms kg-1 appears to be the minimum effective dose for preventing PONV in women undergoing middle-ear surgery.
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Randomized Controlled Trial Clinical Trial
Tropisetron reduces vomiting after tonsillectomy in children.
Nausea and vomiting are common after adenotonsillectomy. Tropisetron is a new, long-acting serotonin antagonist that is an effective antiemetic in adults. Its effect on postoperative nausea and vomiting in children is unknown. ⋯ Children received metoclopramide 0.15 mg kg-1 as a rescue antiemetic. We found that tropisetron reduced the overall incidence of emetic episodes after surgery (29% compared with 65% in control group; P = 0.019) and the incidence of severe vomiting (0% compared with 52% in control group; P < 0.001). We conclude that tropisetron is an effective antiemetic for children undergoing tonsillectomy.
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Holt-Oram syndrome (HOS) is a rare disorder characterized by congenital anomalies of the upper limbs and heart. Cardiac arrhythmias are common in patients with HOS. We successfully managed a 24-yr-old woman with HOS who underwent laparoscopic ovarian cystectomy. Potential problems in the anaesthetic management of patients with HOS are discussed.