ABSTRACT
The aim of our study was to compare dilation forceps tracheostomy and sequential dilator tracheostomy in anaesthetized live adult sheep with respect to the characteristics of the stoma formed and the associated injury. We performed percutaneous tracheostomy on adult sheep randomly allocated to receive either dilation forceps or sequential dilators. Sheep were sacrificed immediately after insertion of the percutaneous tracheostomy and the tracheas dissected. Specimens were examined for site, shape and size of stoma, mucosal lacerations, and posterior wall trauma. Ten sheep had dilation forceps tracheostomy and ten had sequential dilator tracheostomy. All of the specimens were found to have cephalo-caudal mucosal tears, usually crossing tracheal rings. The dilation forceps technique was found to have a larger stoma (28.8 mm vs 24.0 mm, P=0.023). The incidence of posterior needle trauma and mucosal lacerations were common (35% and 50% respectively), but they were not statistically different between the two groups. The role of the mucosal tears in the development of tracheal stenosis is reviewed in the discussion.
Subject(s)
Trachea/injuries , Tracheal Stenosis/etiology , Tracheostomy/adverse effects , Tracheostomy/instrumentation , Analysis of Variance , Animals , Chi-Square Distribution , Disease Models, Animal , Equipment Safety , Female , Male , Probability , Random Allocation , Risk Assessment , Sheep , Statistics, Nonparametric , Tracheal Stenosis/epidemiology , Tracheostomy/methodsABSTRACT
This study compares the speed of onset of effective analgesia in two randomly assigned groups of patients requesting analgesia in labour. Patients in the combined spinal-epidural group (n = 69) were given a subarachnoid injection of 1.5 ml containing bupivacaine 2.5 mg and fentanyl 25 microg for initiation of analgesia. Patients in the epidural group (n = 73) were given an epidural injection of 10 ml containing bupivacaine 12.5 mg and fentanyl 50 microg. Mean (SD) onset times to the first pain-free contraction were 10.0 (5.7) min in the combined spinal-epidural group and 12.1 (6.5) min in the epidural group (p = 0.054). Patients in the combined spinal-epidural group suffered a higher incidence of motor weakness and proprioceptive deficit than those in the epidural group (p = 0.01). The incidence of technique failure and side-effects was similar in the two groups. It is our contention that the statistically nonsignificant difference in onset times does not justify the additional potential for side-effects and the extra cost of the equipment involved in the combined spinal-epidural technique.
Subject(s)
Analgesia, Epidural , Anesthesia, Obstetrical , Anesthesia, Spinal , Adult , Analgesics, Opioid , Anesthetics, Local , Bupivacaine , Female , Fentanyl , Humans , Labor, Obstetric , Pregnancy , Prospective StudiesABSTRACT
A case is described of a near drowning and amphetamine overdose in a patient who developed rapidly progressive coagulopathy, thrombocytopaenia and anuria. As the coagulation abnormality was not perceived to be in keeping with the amphetamine toxicity, a septic and toxological screen were performed which revealed a positive urine result for Pseudonaja texilis envenomation. Despite resuscitation using coagulation factors and monovalent antivenom, the patient died. This case highlights the importance of early testing for envenomation when an atypical coagulopathy is present.
