Asunto(s)
Kava/efectos adversos , Plantas Medicinales/efectos adversos , Enfermedades de la Piel/patología , Urticaria/patología , Enfermedad Aguda , Cuidados Posteriores , Antiinflamatorios/administración & dosificación , Antiinflamatorios/uso terapéutico , Biopsia , Diagnóstico Diferencial , Eritema/inducido químicamente , Eritema/patología , Exantema/inducido químicamente , Exantema/patología , Femenino , Humanos , Prednisolona/administración & dosificación , Prednisolona/uso terapéutico , Prurito/inducido químicamente , Prurito/patología , Enfermedades de la Piel/inducido químicamente , Enfermedades de la Piel/diagnóstico , Enfermedades de la Piel/tratamiento farmacológico , Síndrome de Respuesta Inflamatoria Sistémica/inducido químicamente , Síndrome de Respuesta Inflamatoria Sistémica/tratamiento farmacológico , Síndrome de Respuesta Inflamatoria Sistémica/patología , Resultado del Tratamiento , Urticaria/inducido químicamente , Adulto JovenRESUMEN
Local anaesthesia for fibreoptic bronchoscopy should be given by a safe technique that is not unpleasant to the patient and should provide acceptable conditions for the bronchoscopist. Single injection transcricoid local anaesthesia was compared with the "spray as you go" technique in patients having day case fibreoptic bronchoscopy. Patients were randomised to receive either 100 mg lignocaine by a single cricothyroid puncture or 240 mg lignocaine instilled through the bronchoscope under direct vision. Further doses were given by the operator to both groups as required. The 30 patients receiving transcricoid lignocaine coughed less (3.56 (SD 3.1) coughs/min) than the 32 patients receiving lignocaine through the bronchoscope (5.89 (4.8)/min) despite receiving a lower total dose of lignocaine (322 (25.9) v 451 (20.9) mg). Cricothyroid puncture was not associated with any complications and was not unpleasant for the patients.
Asunto(s)
Anestesia Local/métodos , Broncoscopía/métodos , Lidocaína , Administración Tópica , Atención Ambulatoria/métodos , Femenino , Tecnología de Fibra Óptica , Humanos , Inyecciones/métodos , Masculino , Persona de Mediana Edad , Distribución AleatoriaRESUMEN
Sedation for fibreoptic bronchoscopy should produce optimal conditions for the operator, patient comfort and rapid recovery allowing early discharge home. We have compared a regimen producing 'light' sedation with a more traditional regimen producing 'deep' sedation. Seventy-six patients undergoing fibreoptic bronchoscopy under topical anaesthesia were randomized to receive either light sedation with the short acting opiate, alfentanil (median dose 1.1 mg, range 0.5-2.6 mg) or deep sedation with a combination of papaveretum (median dose 10 mg, range 5-15 mg) and diazepam (median dose 8 mg, range 0-20 mg). Both techniques gave equally good operating conditions, although patients given alfentanil coughed less than those given papaveretum and diazepam (U = 2.814 P less than 0.01). Patients recorded their degree of apprehension on a visual analogue scale prior to sedation and the actual degree of comfort experienced after recovery. There was no significant difference between apprehension or comfort between the groups. This was despite a higher degree of amnesia for an irrelevant object shown during the bronchoscopy in the deeply sedated group (chi 2 = 21.084 P less than 0.001). Patients given alfentanil performed significantly better in a modified Romberg test (chi 2 = 4.357 P less than 0.05) and a visualisation test (t = 3.035 P less than 0.01) two hours after the bronchoscopy. Alfentanil produced good operating conditions, patient comfort, less cough and a more rapid recovery, compared to the deep sedation regimen, and is an ideal sedative for fibreoptic bronchoscopy.