British journal of anaesthesia
-
We describe the use of epidural analgesia for vaginal delivery of a parturient with Klippel-Trenaunay syndrome in whom the use of repeated magnetic resonance imaging during her obstetric care allowed us to see deep haemangiomata. This also allowed the safe sitting of an epidural catheter at L1-2 to provide analgesia for labour and delivery. Klippel-Trenaunay syndrome and the anaesthetic implications of the congenital vascular abnormalities and potential coagulopathy are discussed.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Comparison between tracheal tubes for orotracheal fibreoptic intubation.
We have compared impingement of the tracheal tube against the larynx using a standard preformed tube, warmed preformed tube or two flexible spiral-wound tracheal tubes with different tip designs, in 100 adult patients undergoing orotracheal fibreoptic intubation under general anaesthesia, in a prospective, randomized study. The rates of impingement were 20 of 30 with the standard tube, 12 of 30 with the warmed standard tube (P = 0.07) and eight of 20 with both spiral tubes. ⋯ Manipulations after impaction led to oesophageal intubation in one patient, and in one patient fibreoptic intubation failed. We conclude that resistance to the tracheal tube occurred frequently when the spiral-wound tubes were used.
-
Randomized Controlled Trial Clinical Trial
Ketoprofen, diclofenac or ketorolac for pain after tonsillectomy in adults?
We have compared the analgesic and opioid sparing effect of three i.v. non-steroidal anti-inflammatory drugs with placebo in a randomized, double-blind, placebo-controlled study in 80 adult patients after elective tonsillectomy. A standard anaesthetic was used. After induction of anaesthesia, patients received ketoprofen 100 mg, diclofenac 75 mg or ketorolac 30 mg by i.v. infusion over 30 min. ⋯ The incidence of nausea was 44-54%. There were no differences in the incidence of other adverse reactions. We conclude that all three non-steroidal anti-inflammatory drugs were superior to placebo after tonsillectomy.
-
The potential for serious complications after venous air embolism and successful malpractice liability claims are the principle reasons for the dramatic decline in the use of the sitting position in neurosurgical practice. Although there have been several studies substantiating the relative safety compared with the prone or park bench positions, its use will continue to decline as neurosurgeons abandon its application and trainees in neurosurgery are not exposed to its relative merits. How can individual surgeons continue to use this position? Will individual, difficult surgical access cases be denied the obvious technical advantages of the sitting position? Limited use of the sitting position should remain in the neurosurgeon's armamentarium. ⋯ Measures to minimize hypotension associated with the sitting position include a slow, staged positioning over 5-10 min and use of the 'G suit' inflated with compressed air applied to the lower extremities and pelvis. Use of the sitting or upright position for patients undergoing posterior fossa and cervical spine surgery presents unique challenges for the anaesthetist. With appropriate patient selection and preparation, and using prudent intraoperative monitoring and anaesthetic techniques, selected patients should still benefit from the optimum access to mid-line lesions, improved cerebral venous decompression, lower intracranial pressure and enhanced gravity drainage of blood and CSF associated with the sitting position.
-
Randomized Controlled Trial Clinical Trial
'Alveolar recruitment strategy' improves arterial oxygenation during general anaesthesia.
Abnormalities in gas exchange during general anaesthesia are caused partly by atelectasis. Inspiratory pressures of approximately 40 cm H2O are required to fully re-expand healthy but collapsed alveoli. However, without PEEP these re-expanded alveoli tend to collapse again. ⋯ Application of PEEP also had a significant effect on oxygenation; no such intra-group difference was observed in the ZEEP group. No complications occurred. We conclude that during general anaesthesia, the alveolar recruitment strategy was an efficient way to improve arterial oxygenation.