A prospective randomized study of the potential benefits of thoracic epidural anesthesia and analgesia in patients undergoing coronary artery bypass grafting.

We performed an open, prospective, randomized, controlled study of the incidence of major organ complications in 420 patients undergoing routine coronary artery bypass graft surgery with or without thoracic epidural anesthesia and analgesia (TEA). All patients received a standardized general anesthetic. Group TEA received TEA for 96 h. Group GA (general anesthesia) received narcotic analgesia for 72 h. Both groups received supplementary oral analgesia. Twelve patients were excluded-eight in Group TEA and four in Group GA-because of incomplete data collection. New supraventricular arrhythmias occurred in 21 of 206 patients (10.2%) in Group TEA compared with 45 of 202 patients (22.3%) in Group GA (P = 0.0012). Pulmonary function (maximal inspiratory lung volume) was better in Group TEA in a subset of 93 patients (P < 0.0001). Extubation was achieved earlier (P < 0.0001) and with significantly fewer lower respiratory tract infections in Group TEA (TEA = 31 of 206, GA = 59 of 202; P = 0.0007). There were significantly fewer patients with acute confusion (GA = 11 of 202, TEA = 3 of 206; P = 0.031) and acute renal failure (GA = 14 of 202, TEA = 4 of 206; P = 0.016) in the TEA group. The incidence of stroke was insignificantly less in the TEA group (GA = 6 of 202, TEA = 2 of 206; P = 0.17). There were no neurologic complications associated with the use of TEA. We conclude that continuous TEA significantly improves the quality of recovery after coronary artery bypass graft surgery compared with conventional narcotic analgesia.

Training nursing staff in airway management for resuscitation. A clinical comparison of the facemask and laryngeal mask.

The place of the laryngeal mask in emergency airway management by nonanaesthetists has yet to be established. We have compared the tidal volume achieved by nurses during hand ventilation using standard resuscitation equipment with a facemask, with or without a Guedel airway, and following placement of a laryngeal mask in the same patients. The tidal volumes measured while using the laryngeal mask were significantly greater (p < 0.01) than those measured during facemask ventilation.

AxAudit--anaesthetic audit system.

A bar code based computerised anaesthetic audit system is described. The system consists of a data entry and validation module resident on a remote hand-held computer and a central database module resident on a desktop computer, capable of conducting extensive searches, analysis, graphing and reporting of captured data. Information is entered into the computer by 'swiping' a bar code reader across required bar codes. Information entered is constantly validated and the computer ensures a minimum data set is captured for every patient. Since data is transferred directly into a computer at the point of clinical activity, a large data set can be presented to the clinician, ensuring as complete a patient record as possible and avoiding the problems associated with traditional form-filling and the subsequent transfer of information onto a computer. The hand-held computer has data cards which can hold information on approximately 200 patients. These cards can be inserted directly into a card reader attached to a desktop computer, thus automating the process of data transfer. The AxSys Anaesthetic Audit system, AxAudit, is a bar code based, computerised audit system developed with the aim of executing effective audit in the course of normal clinical activity.

Continuous collection of pulse oximetry data: a new, inexpensive, portable computerized method.

The availability of reliable pulse oximetry equipment has led to interest in identifying patterns of hypoxaemia in the postoperative period. Methods for the computerized collection and analysis of pulse oximetry data have been described, but these require continuous use of a relatively powerful computer system throughout both the monitoring (data collection) and analysis periods. We have designed a technique which uses a small, portable and relatively inexpensive computer unit for data collection, after which the data may be transferred to a more powerful computer for analysis. Appropriate programming and choice of software have produced a relatively "user friendly" system which can be operated successfully even with minimal computing experience. The unit has the potential to be modified to form the basis of a "medical advice system" which could be used for the "intelligent" monitoring of high risk patients.

Self-administered isoflurane in labour. A comparative study with Entonox.

Entonox (50% nitrous oxide in oxygen) and isoflurane (0.75% in oxygen) were compared as analgesics in the first stage of labour in 32 consenting women. The drugs were self-administered and given in random sequence, each during five consecutive uterine contractions. Each patient acted as her own control. Linear analogue pain scores were significantly lower (p less than 0.001) with isoflurane than with Entonox, but scores for drowsiness were higher for isoflurane. Further study is needed to assess the effects of more prolonged use of isoflurane in labour.