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C Yeow, L Greaney, C Foy, W King, B Patel
The Difficult Airway Society 2015 guidelines for management of unanticipated difficulties in tracheal intubation in adults have generated much discussion regarding Plan D: emergency front-of-neck access with a scalpel-bougie cricothyroidotomy technique. There is concern that this technique may not provide an adequate pathway for the bougie and subsequently the tracheal tube, especially in obese patients with deeper airway structures. This could lead to the formation of a false passage, trauma and failure. A novel cricothyroidotomy introducer, 8 mm wide and 170 mm long, with a sharp leading edge and guiding channel to pass a bougie into the trachea, has been designed to complement the scalpel cricothyroidotomy technique...
July 13, 2018: Anaesthesia
N Chrimes, S D Marshall
No abstract text is available yet for this article.
July 11, 2018: Anaesthesia
A A Klein, C R Bailey, A J Charlton, E Evans, M Guckian-Fisher, R McCrossan, A F Nimmo, S Payne, K Shreeve, J Smith, F Torella
The use of cell salvage is recommended when it can be expected to reduce the likelihood of allogeneic (donor) red cell transfusion and/or severe postoperative anaemia. We support and encourage a continued increase in the appropriate use of peri-operative cell salvage and we recommend that it should be available for immediate use 24 h a day in any hospital undertaking surgery where blood loss is a recognised potential complication (other than minor/day case procedures).
July 10, 2018: Anaesthesia
S Salman, E K Y Tang, L C Cheung, M N Nguyen, D Sommerfield, L Slevin, L Y Lim, B S von Ungern Sternberg
Midazolam is one of many bitter drugs where provision of a suitable oral paediatric formulation, particularly in the pre-anaesthetic setting, remains a challenge. To overcome this problem, a novel chocolate-based tablet formulation has been developed with positive pre-clinical results. To further investigate the potential of this formulation, 150 children aged 3-16 years who were prescribed midazolam as a premedication were randomly assigned to receive 0.5 either as the novel formulation or an intravenous solution given orally, which is the current standard at our institution...
July 9, 2018: Anaesthesia
(no author information available yet)
The peri-operative use of angiotensin-converting enzyme inhibitors or angiotensin-2 receptor blockers is thought to be associated with an increased risk of postoperative acute kidney injury. To reduce this risk, these agents are commonly withheld during the peri-operative period. This study aimed to investigate if withholding angiotensin-converting enzyme inhibitors or angiotensin-2 receptor blockers peri-operatively reduces the risk of acute kidney injury following major non-cardiac surgery. Patients undergoing elective major surgery on the gastrointestinal tract and/or the liver were eligible for inclusion in this prospective study...
July 9, 2018: Anaesthesia
M I Rudolph, H V Chitilian, P Y Ng, F P Timm, A V Agarwala, A B Doney, S K Ramachandran, T T Houle, M Eikermann
Inappropriate dosing of neostigmine for antagonism of neuromuscular blockade has been associated with postoperative pulmonary complications. We evaluated the effects of a quality improvement initiative tailored to optimise the use of neostigmine in antagonising neuromuscular blockade on postoperative pulmonary complications, costs and duration of hospital stay. The quality improvement initiative consisted of: a reduction in available neostigmine aliquot sizes; a cognitive aid; an educational component; and a financial incentive for the intra-operative documentation of train-of-four measurement before administration of neostigmine...
July 4, 2018: Anaesthesia
J J Mu, T Jiang, L P Deng, S W Choi, M G Irwin, V M Yuen
Induction of anaesthesia with target-controlled infusion of propofol may be achieved by stepwise increases in effect-site concentration until the patient loses consciousness (titration method), or by setting a high effect-site concentration target and observing the calculated effect-site concentration at loss of consciousness (standard method). When the estimated effect-site concentration at loss of consciousness is accurate, the difference between effect-site concentration at loss of consciousness and at recovery of consciousness should be small...
June 29, 2018: Anaesthesia
S O'Hanlon, J Rechner
No abstract text is available yet for this article.
June 22, 2018: Anaesthesia
A Saporito, C Quadri, X Capdevila
Injection pressure monitoring provides valuable information to prevent intraneural injections and possibly consequent nerve damage during peripheral nerve block. However, the measurement of injection pressure along the injection line is inaccurate as it is influenced by several variables. The aim of this study was to test a new system for precise injection pressure monitoring at the needle tip in a cadaveric model. The system consists of a miniaturised pressure sensor embedded within the needle shaft that is connected via an optical fibre to an external control unit...
June 2, 2018: Anaesthesia
M Baeriswyl, P Taffé, K R Kirkham, I Bathory, V Rancati, X Crevoisier, S Cherix, E Albrecht
Animal data have demonstrated increased block duration after local anaesthetic injections in diabetic rat models. Whether the same is true in humans is currently undefined. We, therefore, undertook this prospective cohort study to test the hypothesis that type-2 diabetic patients suffering from diabetic peripheral neuropathy would have increased block duration after ultrasound-guided popliteal sciatic nerve block when compared with patients without neuropathy. Thirty-three type-2 diabetic patients with neuropathy and 23 non-diabetic control patients, scheduled for fore-foot surgery, were included prospectively...
June 2, 2018: Anaesthesia
I Costache, A Pawa, F W Abdallah
No abstract text is available yet for this article.
June 2, 2018: Anaesthesia
C R Bain, D F Draxler, R Taylor, S Wallace, O Gouldthorpe, T B Corcoran, P S Myles, R L Medcalf, K Bozaoglu
Dexamethasone is often administered to surgical patients for anti-emetic prophylaxis. This study examined the early (up to 24 h) in-vivo effects of dexamethasone (8 mg) to demonstrate the magnitude and temporal nature of changes on circulating peripheral blood mononuclear cell gene expression and activation in 10 healthy male volunteers. Blood samples were drawn at baseline, 2 h, 4 h and 24 h. Gene expression was measured using quantitative real-time polymerase chain reaction. Cytokine expression was measured using multiplex immuno-assays...
May 28, 2018: Anaesthesia
B M Choi, C Park, Y H Lee, H Shin, S H Lee, S Jeong, G J Noh, B Lee
Although surrogate measures to quantify pain intensity have been commercialised, there is a need to develop a new index with improved accuracy. The aim of this study was to develop a new analgesic index using nasal photoplethysmography data. The specially designed sensor was placed between the columella and the nasal septum to acquire nasal photoplethysmography in surgical patients. Nasal photoplethysmography and Surgical Pleth Index® (GE Healthcare) data were obtained for 14 min both in the absence (pre-operatively) or presence (postoperatively) of pain in a group of surgical patients, each patient acting as their own control...
May 23, 2018: Anaesthesia
W M Wilson, A F Smith
No abstract text is available yet for this article.
May 23, 2018: Anaesthesia
A P Toft-Petersen, P Ferrando-Vivas, D A Harrison, K Dunn, K M Rowan
In the UK, a network of specialist centres has been set up to provide critical care for burn patients. However, some burn patients are admitted to general intensive care units. Little is known about the casemix of these patients and how it compares with patients in specialist burn centres. It is not known whether burn-specific or generic risk prediction models perform better when applied to patients managed in intensive care units. We examined admissions for burns in the Case Mix Programme Database from April 2010 to March 2016...
May 15, 2018: Anaesthesia
S McCarthy, R M Cooper
No abstract text is available yet for this article.
May 4, 2018: Anaesthesia
B W Koo, A Y Oh, H S Na, H J Lee, S B Kang, D W Kim, K S Seo
There have been few objective evaluations of the effects of deep neuromuscular blockade on intra-operative conditions. In this prospective randomised controlled study, we evaluated the effects of deep neuromuscular block on surgical conditions during laparoscopic colorectal surgery. Patients were randomly allocated using a computer-generated randomisation code to either moderate (train-of-four count 1-2 maintained and antagonised with neostigmine) or deep (post-tetanic count 1-2 maintained and reversed with sugammadex) levels of neuromuscular blockade...
May 4, 2018: Anaesthesia
J W Durrand, K Wagstaff, A Kasim, L Cawthorn, G R Danjoux, E Kothmann
Arm-crank ergometry may be useful in patients unable to pedal, for instance due to peripheral arterial disease. Twenty participants with small abdominal aortic aneurysm undertook two serial arm-crank tests and then a pedal test, four of whom had indeterminate anaerobic thresholds, precluding analysis. The mean (SD) peak arm and leg oxygen consumptions in 16 participants were 13.71 (2.62) .min-1 and 16.82 (4.44) .min-1 , with mean (SD) individual differences of 3.11 (2.48) .min-1 , p = 0...
May 4, 2018: Anaesthesia
T Nakanishi, M Yoshimura, S Sakamoto, T Toriumi
Tracheal intubation without neuromuscular blockade may be associated with worse intubating conditions and increased laryngeal morbidity. We hypothesised that tracheal intubation using the McGRATH™ MAC videolaryngoscope would not increase postoperative hoarseness, even without neuromuscular blockade. In this prospective, randomised, parallel-group, double-blind, non-inferiority trial, 248 patients were randomly assigned to tracheal intubation with or without neuromuscular blockade using rocuronium. Hoarseness and sore throat were evaluated at 24 h and 48 h postoperatively...
May 4, 2018: Anaesthesia
(no author information available yet)
No abstract text is available yet for this article.
July 2018: Anaesthesia
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