[Patient-controlled continuous epidural analgesia vs intravenous remifentanil infusion for labour anaesthesia]. / Porównanie jakosci znieczulenia u rodzacych otrzymujacych remifentanil metoda analgezji dozylnej sterowanej przez pacjenta lub ciaglego znieczulenia zewnatrzoponowego.

BACKGROUND: Although epidural anaesthesia has become a standard method for labour analgesia all over the world, it is far from being ideal because of side effects and contraindications. Many alternative techniques have therefore been proposed, including the continuous infusion of remifentanil. Encouraged by positive reports, we compared the efficacy of patient-controlled remifentanil infusion (PCA) with patient-controlled continuous epidural analgesia (PCEA). METHODS: Fifty-two ASA I and II parturients were arbitrarily allocated, without randomisation, to two groups to receive PCEA with 0.125% bupivacaine and 0.2 microg kg(-1) fentanyl (basic infusion 1 mL h(-1), bolus 4 mL, lock-out time 15 min) or remifentanil PCA (0.2 microg kg(-1) bolus doses, without basic infusion, lock-out time 2 min). The intensity of pain was assessed using the VAS scale every 15 min in the PCEA group and every 10 min in the PCA group. RESULTS: During the first two hours of labour, the VAS score was significantly lower in the PCEA group. Later there was no difference between the groups. The clinical status of the newborns was similar. CONCLUSION: The results are difficult to interpret since there was no randomisation and parturients participated in decisions about allocation to one of the study groups. Analgesia provided by remifentanil was assessed as highly acceptable by the patients and the drug can be regarded as a safe alternative to epidural analgesia during labour.

Using a high-flow respiratory system (Vapotherm) within a high dependency setting.

BACKGROUND: Vapotherm 2000i is a non-invasive high-flow respiratory support system used mainly in the treatment of type 1 respiratory failure. It uses a mixture of oxygen and air to deliver a set concentration via nasal cannula (or tracheostomy mask). The advantage of this system is the high humidity achieved using the integral heated water system. The system has been used in neonatal practice as a replacement for conventional continuous positive airway pressure (CPAP) but there is little published research within the adult setting about its use. AIM: This study discusses the indications for the use of this non-invasive high-flow respiratory support system, the system set up, the benefits and complications of the system. AUDIT DESIGN: An audit of 72 patients was undertaken within the Surgical High Dependency Unit that collected data on the types of patient receiving the therapy, its effectiveness and patient experience. AUDIT FINDINGS: The audit demonstrated reduced respiratory rate and improvement in oxygenation for treated patients. CONCLUSION: A non-invasive high-flow respiratory support system can be effective at improving oxygenation in hypoxic patients. Patients were generally satisfied with the system and the system seems suitable for use in an adult surgical high dependency setting.

The influence of acute hypercapnia on the quantity and oxidative metabolism of bronchoalveolar lavage-derived leukocytes in the mechanically ventilated rabbit.

BACKGROUND: Permissive hypercapnia exerts a protective influence in tissue injury, possibly by attenuating free radical activity. Increased CO2 concentrations may decrease the production of phagocyte reactive oxygen intermediates (ROI). In this study, we used bronchoalveolar lavage (BAL) to determine whether isooxic permissive hypercapnia due to hypoventilation would influence neutrophil recruitment into alveolar spaces and ROI production of BAL phagocytes, as measured by luminol dependent chemiluminescence. MATERIAL/METHODS: 27 Chinchilla rabbits randomized into three groups: control group (C; n=7), normocapnia (NC; n=10), and hypercapnia (HC; n=10) were anaesthetized with pentobarbitone and intubated. Bronchoalveolar lavage was obtained either after intubation (controls) or after mechanical ventilation lasting 240 minutes under normocapnia or permissive hypercapnia conditions. BAL cells were counted and luminol-dependent chemiluminescence estimations were performed. RESULTS: The BAL neutrophil count was significantly higher in the hypercapnia group than in normocapnia animals. The chemiluminescence of opsonized zymosan-stimulated cells was significantly higher in the normocapnia group than in the controls; the differences between the HC and NC animals, and between the HC and control animals, did not reach statistical significance. CONCLUSIONS: In the mechanically ventilated rabbit under pentobarbitone anaesthesia, acute isooxic hypercapnia due to hypoventilation increases neutrophil BAL count, without direct impact on mixed BAL-cell chemiluminescence; moreover, conventional ventilation increases the chemiluminescence of opsonized zymosan-stimulated BAL cells