Continuous spinal anaesthesia.
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Biomedical subjects
Publications and source records attributed to N M Denny.
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The rôle of the laryngeal mask airway for thyroid and parathyroid surgery was studied in 97 consecutive patients. In 50% the technique combined electrical stimulation of the recurrent laryngeal nerve with visualisation of vocal cord movement via a fibreoptic bronchoscope. Stimulation was required in 10% to assist in identifying recurrent laryngeal nerve position during difficult surgical dissection. In the remaining 40% stimulation was used to confirm nerve integrity and for teaching purposes. Tracheal intubation was required for seven patients but in only two of these was intubation unplanned. The incidence of postoperative recurrent laryngeal nerve dysfunction was zero. These data suggest that the technique offers a safe alternative in airway management and may provide advantages in terms of preservation of recurrent laryngeal nerve function.
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The incidence of airway complications following general anaesthesia using either a tracheal tube or a laryngeal mask airway was compared in a prospective, randomized study of 79 patients undergoing elective cataract surgery using a standard anaesthetic technique. Assessment was made both at extubation (which was taken to include removal of the laryngeal mask airway) and for 25 min afterwards. There was a significantly greater incidence of coughing prior to extubation (P < 0.001), at extubation (P < 0.001) and after extubation (P < 0.001) in the tracheal group than in the laryngeal mask airway group. No other airway complications were seen in either group.
We report our experience of using the laryngeal mask airway (LMA) in 13 consecutive patients undergoing thyroid surgery and discuss the advantages and limitations of the technique. We also describe a method, based on the use of the LMA, for identifying and preserving the recurrent laryngeal nerve during thyroid surgery.
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Two similar groups of patients undergoing coronary artery bypass grafting received either atracurium or vecuronium infusions for neuromuscular blockade. Both groups demonstrated a marked reduction in neuromuscular blocking requirements during hypothermic bypass at 30 C. The ratio of the dose rates at 30 C to that at 37 C was significantly less with vecuronium (p less than 0.01).
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The quality of analgesia and incidence of side effects when using a continuous subarachnoid infusion of diamorphine were assessed in 28 postoperative patients who had undergone major abdominal or lower limb surgery. Excellent pain relief was obtained without depression of the respiratory rate. Four patients complained of headache, and 50% of those patients not already catheterized preoperatively subsequently required it for urinary retention. There was no evidence of sepsis related to the indwelling subarachnoid catheter.
BACKGROUND AND OBJECTIVES: The quality of analgesia and subsequent morphine requirements following spinal anesthetic block (SAB) or combined sciatic and femoral (3-in-1) block (SFB) for total knee arthroplasty were compared. METHODS: The 39 patients studied were randomly assigned to receive either SAB (n = 19) or SFB (n = 20). All patients received a standardized general anesthetic, patient-controlled analgesia, and regular diclofenac. Visual analog pain scores and morphine requirements were recorded for 48 hours following surgery. Observations were grouped into four 12-hour periods. Pain scores (0-10 cm) were expressed as 95% confidence intervals; the criterion for analgesic success was a confidence interval in the range 0-3 cm. RESULTS: Although pain-free on awakening, the SAB patients failed to achieve analgesic success in any of the four periods, while the SFB patients did so in three of the four periods. Morphine consumption was significantly higher in the SAB group during the first two periods but similar to the SFB group thereafter. CONCLUSION: In comparison with SAB, SFB resulted in superior analgesia and reduced morphine consumption for the first 24 hours following total knee arthroplasty.