British journal of anaesthesia
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Randomized Controlled Trial Comparative Study
Pathways through the nose for nasal intubation: a comparison of three endotracheal tubes.
In nasotracheal intubation, there are two main pathways in the nostril through which the endotracheal tube may pass. The lower pathway lies along the floor of the nose underneath the inferior turbinate. The upper pathway lies above the inferior turbinate, just below the middle turbinate. The lower pathway may be considered to be the safer route as it is located away from the middle turbinate and cribiform plate. ⋯ Endotracheal tubes, particularly preformed tubes, frequently take the less favourable pathway during nasotracheal intubation, in spite of specific attempts to avoid this.
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Errors in the judgement of puncture level during neuraxial anaesthesia can lead to significant complications. The aim of this study was to assess, in obstetric anaesthesia, the accuracy of clinical determination of the lumbar spinal interspace level, using surface ultrasound imaging as control. ⋯ The observed differences between clinical and ultrasonic identification of spinal puncture level highlight the potential for serious complications associated with the performance of neuraxial blocks above the spinous process of L3 in the parturient. With the increase in popularity of techniques involving puncture of the dura mater for labour anaesthesia, we feel that awareness of this risk is important.
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Randomized Controlled Trial Comparative Study
Controlled comparison between betamethasone gel and lidocaine jelly applied over tracheal tube to reduce postoperative sore throat, cough, and hoarseness of voice.
Postoperative sore throat, cough, and hoarseness of voice though minor sequelae after general tracheal anaesthesia can be distressing to the patient. ⋯ A wide spread application of betamethasone gel on the tracheal tube decreases the incidence and severity of postoperative sore throat, cough, and hoarseness of voice.
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Review Meta Analysis Comparative Study
Epidural analgesia compared with peripheral nerve blockade after major knee surgery: a systematic review and meta-analysis of randomized trials.
The relative analgesic efficacy and side-effect profile of peripheral nerve blockade (PNB) techniques compared with lumbar epidural analgesia for major knee surgery is unclear. We undertook a systematic review and meta-analysis of all randomized trials comparing epidural analgesia with PNB for major knee surgery. Eight studies were identified that had enrolled a total of 510 patients of whom 464 (91%) had undergone total knee joint replacement. ⋯ Two studies reported a higher incidence of urinary retention in the epidural group. Patient satisfaction was higher with PNB in two of three studies which measured this, although rehabilitation indices were similar. PNB with a femoral nerve block provides postoperative analgesia which is comparable with that obtained with an epidural technique but with an improved side-effect profile and is less likely to cause a severe neuraxial complication.
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Randomized Controlled Trial
Preventive effects of perioperative parecoxib on post-discectomy pain.
Cyclooxygenase inhibitor treatment is viewed increasingly critical because of safety considerations, and there are several open questions on their optimal use. ⋯ Perioperative parecoxib compared with postoperative parecoxib improves post-discectomy pain and results in a reduction in adverse effects associated with opioid therapy. Postoperative parecoxib, or a single pre-incisional parecoxib dose, does not significantly improve post-discectomy pain or opioid side-effects up to 3 days after surgery.