British journal of anaesthesia
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Review Randomized Controlled Trial Clinical Trial
NICE guidelines for central venous catheterization in children. Is the evidence base sufficient?
Recent guidelines from the National Institute for Clinical Excellence (NICE) recommend the use of ultrasound guidance for central venous catheterization in children. This study prospectively examined the use of ultrasound guidance for central venous catheterization in children undergoing heart surgery. ⋯ These results are different from the published results on which the NICE guidelines were based; however, the evidence base in children is small. There is currently insufficient evidence to support the use of ultrasound guidance for central venous catheterization in children.
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Randomized Controlled Trial Clinical Trial
Epidural test dose with levobupivacaine and ropivacaine: determination of ED(50) motor block after spinal administration.
When a test is required to detect a possible intrathecal catheter, many would seek to use the same local anaesthetic as that used for epidural analgesia. The rapid onset of inappropriate motor block after a local anaesthetic administered epidurally implies intrathecal spread. Because of claims of greater sensory-motor separation, or because of reduced potency compared with bupivacaine, the efficacy of the new local anaesthetics in intrathecal testing has been questioned. The aim of this study was to establish the feasibility of a test dose for an inadvertent intrathecal catheter using ropivacaine and levobupivacaine, and to establish the dose required. ⋯ Both local anaesthetics produce evidence of motor block within 5 min of intrathecal injection and could serve as tests of intrathecal administration. Derived ED(95) values suggest 10 mg doses should be effective, but this study did not measure predictive value. Ropivacaine is less potent for motor block than levobupivacaine by a factor of 0.83 (P<0.04).
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Comment Letter Case Reports
Another case of use of the ProSeal laryngeal mask airway in a difficult obstetric airway.
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Case Reports
Retrieval of a retrograde catheter using suction, in patients who cannot open their mouths.
In difficulty, tracheal intubation can be facilitated by passing a retrograde catheter, but the mouth has to be opened for the retrieval of the catheter from the pharynx. Two patients with ankylosis of a temporomandibular joint were unable to open their mouth, and required general anaesthesia for gap arthroplasty. ⋯ Catheter-guided tracheal intubation was done without complication. A suction catheter can assist retrograde retrieval of a catheter to aid intubation in patients who cannot open the mouth.