ABSTRACT
A randomised, single-blinded study was conducted to compare patient-controlled epidural analgesia with continuous infusion epidural analgesia for the treatment of pain following post-traumatic pelvic reconstruction. The patient-controlled group (n = 11) received a background infusion of 4 ml.h-1 of bupivacaine 0.125% with fentanyl 1 microgram.ml-1, and 3-6 ml bolus doses, self administered, as required (with a 15 min lockout interval). The continuous infusion group (n = 12) received a continuous infusion of the same solution through an identical apparatus, but with the demand button deactivated. This was started at 10 ml.h-1 and adjusted by the anaesthetist, as required, up to a maximum of 25 ml.h-1. Pain scores, side effects, and the volumes of drug infused were recorded over the first 3 postoperative days. One patient from each group was withdrawn because of catheter-related problems. Pain scores were similar and the incidence of nausea and pruritus was low in both groups. There was no recorded instance of respiratory depression or hypotension and there was no significant difference between the groups in the volumes of drug solution received. Patient satisfaction was equally very good in both groups. Patient-controlled epidural analgesia is an effective means of providing pain relief after post-traumatic pelvic reconstruction, but did not significantly reduce analgesic requirements in comparison with continuous infusion epidural analgesia.
Subject(s)
Analgesia, Epidural , Analgesia, Patient-Controlled , Fractures, Bone/surgery , Pain, Postoperative/drug therapy , Pelvic Bones/injuries , Adult , Bupivacaine , Female , Fentanyl , Humans , Male , Pain Measurement , Patient Satisfaction , Single-Blind MethodABSTRACT
The advantages of endotracheal intubations are many: patency of airway is reasonably assured, secretions may be removed easily from the tracheobronchial tree, the airway is better protected against aspiration, ventilation can be regulated, and drugs can be administered. The procedure is the "gold standard" of airway control, and the oral route is the most common used. The patient is assessed for potential difficulties that may arise from abnormalities of face and mouth: large face, large tongue, hypoplastic mandible, prominent or diseased maxillary teeth or facial fractures; or abnormalities of the neck: potential or real cervical spine instability, swelling, or laryngeal trauma. A plan is devised, together with one or more alternatives, should unforeseen difficulties arise, and in adherence to the principle of never removing the compensations of a coping patient. The skill is learned and practiced so that a gentle facility is always present at times of greatest need.
Subject(s)
Intubation, Intratracheal/methods , Cervical Vertebrae , Emergencies , Humans , Intubation, Intratracheal/adverse effects , Mouth , Mouth Abnormalities , NeckABSTRACT
Blind nasotracheal intubation presumes a spontaneously breathing patient but offers a very useful alternative method to instrumented access to the airway and is used primarily in traumatized patients whose cervical spines are suspect. It has a high success rate (90-92 per cent), even when the operator is relatively inexperienced, and is associated with few complications (10 per cent or fewer); a rate that is lower when there is adequate time to prepare the patient with vasoconstrictor and topical anesthesia. The most common complication is epistaxis. Surgical methods of intubation also are discussed of which cricothyroidostomy currently enjoys prominence.
