British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
P6 acupuncture and postoperative vomiting after tonsillectomy in children.
We have studied the effect of P6 acupuncture on postoperative vomiting in 45 children undergoing tonsillectomy. After induction of anaesthesia and before the start of surgery, 50% of the patients received P6 acupuncture (in the middle of the ventral surface of the wrist) for 5 min. There was no difference in the incidence of vomiting between the acupuncture (39%) and non-acupuncture (36%) groups. We conclude that, when administered after induction of anaesthesia, P6 acupuncture is ineffective in reducing vomiting after tonsillectomy in children.
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Randomized Controlled Trial Comparative Study Clinical Trial
Use of a 25-gauge Whitacre needle to reduce the incidence of postdural puncture headache.
We studied 200 orthopaedic inpatients (111 males) aged 15-84 yr who received spinal anaesthesia with one of two types of Whitacre spinal needle: 22-gauge or 25-gauge. The incidence of headache, backache, failure of spinal anaesthesia and patient acceptability was investigated using a questionnaire. The incidence of postdural puncture headache (PDPH) was 4% in the 22-gauge group and 2% in the 25-gauge group. ⋯ Spinal anaesthesia was carried out successfully in all patients in both groups. Patient acceptance was high (98%) and there were no serious complications observed. We conclude that spinal anaesthesia is easy to perform with a 25-gauge pencil-point needle and is associated with a low incidence of PDPH.
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Randomized Controlled Trial Clinical Trial
Pressure support ventilation using a new tracheal gas injection tube.
In order to explore new types of jet ventilation, we tested a tracheal gas injection tube (TGIT) which included six thin capillaries and provided high pressure injection. The driving pressure was chosen to yield a plateau of inspiratory tracheal pressure of 10 cm H2O. An original controller was built to monitor spirometry and trigger injection in order to deliver both pressure controlled ventilation (PCVTGIT) and a new mode of inspiratory pressure support jet ventilation (IPSTGIT). ⋯ IPSTGIT, compared with spontaneous breathing increased minute ventilation (from 5.7 (SD 1.6) to 7.1 (1.7) litre min-1) (P less than 0.001). It reduced the total work of breathing (from 0.625 (0.223) to 0.263 (0.151) J litre-1, respectively) (P less than 0.01) and the occlusion pressure (from 2.62 (1.28) to 1.36 (0.74) cm H2O, respectively) (P less than 0.01). It is concluded that this TGIT used with a specific system for sensing and triggering ventilation allows inspiratory pressure support during low frequency jet ventilation.
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Comparative Study
Comparison of contemporaneous and retrospective assessment of postoperative pain using the visual analogue scale.
We have assessed postoperative pain in 50 patients who had undergone total abdominal hysterectomy, using repeated contemporaneous and single retrospective visual analogue scores. There were significant correlations between the median, mean and greatest contemporaneous scores, and the single retrospective scores, but there was a wide scatter of results among and within individual patients. We conclude that the wide variability between the two methods of assessment suggests that the two techniques should not be used interchangeably.
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The presence of an intracranial neoplasm (ICN) during pregnancy has serious implications for the anaesthetic management of labour and delivery. The physiological changes of pregnancy and labour are potentially hazardous to women with ICN, but the provision of adequate pain relief during labour reduces the risk to the mother. Extradural anaesthesia is the only technique that provides pain-free labour reliably, but it carries added risks. ⋯ None suffered any complication related to the anaesthetic technique. At present, there are no published data on the influence of anaesthetic management on outcome of labour and delivery in patients with ICN. Anaesthetists should report such cases so that the relative risks of different management strategies may be assessed.