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Anaesthesia

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https://www.readbyqxmd.com/read/28102539/determination-of-the-median-effective-dose-ed50-of-spinal-chloroprocaine-in-labour-analgesia
#1
M Coppens, S Anssens, A Parashchanka, K Roelens, E Deschepper, S De Hert, P F Wouters
The primary goal of this study was to determine the median effective dose (ED50 ) of spinal chloroprocaine for labour analgesia. Thirty-eight parturients requesting neuraxial analgesia were enrolled. Doses of 1% chloroprocaine were determined by the technique of up-down sequential allocation, with an initial dose of 20 mg and steps of 2 mg. The chloroprocaine spinal dose was given as the spinal component of a combined spinal-epidural, which was then supplemented with an epidural dose of 7.5 μg sufentanil in 7 ml saline...
January 19, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28094434/the-effect-of-remifentanil-on-propofol-requirements-to-achieve-loss-of-response-to-command-vs-loss-of-response-to-pain
#2
H B Scott, S W Choi, G T C Wong, M G Irwin
When providing total intravenous anaesthesia, careful selection of end-points is required in titrating dose to effect during induction. Although propofol and remifentanil have predominantly different pharmacodynamic effects, they are seen to interact in achieving loss of consciousness and analgesia. To highlight these differences, we performed a double-blind, randomised controlled trial, comparing one group of patients receiving propofol alone (n = 42) with another group receiving remifentanil plus propofol (n = 46) as a target-controlled infusion of remifentanil (Minto; 3 ng...
January 17, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28092106/a-randomised-controlled-trial-examining-the-effect-of-acupuncture-at-the-ex-hn3-yintang-point-on-pre-operative-anxiety-levels-in-neurosurgical-patients
#3
M D Wiles, J Mamdani, M Pullman, J C Andrzejowski
Pre-operative anxiety is an unpleasant state of psychological distress that occurs in up to 87% of patients awaiting neurosurgical procedures. Sedative medication is undesirable in this population due to the need for early postoperative neurological assessment. Acupuncture has previously been shown to reduce pre-operative anxiety, but studies involving neurosurgical patients are lacking. This single-centre, prospective, randomised controlled trial was designed to determine the effect of acupuncture at the EX-HN3 (Yintang point) on pre-operative anxiety levels in neurosurgical patients...
January 16, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28070884/a-national-survey-of-neurological-monitoring-practice-after-obstetric-regional-anaesthesia-in-the-uk
#4
E Roderick, J Hoyle, S M Yentis
Neuraxial anaesthesia is widely used in obstetrics and neurological complications are rare. However, when they occur, subsequent investigation and management are time-critical and correlate with the extent of neurological recovery. The Third National Audit Project recommended the implementation of guidelines in obstetric epidural management, including advice on monitoring for early signs of problems and acting upon concerns. However, no national guideline exists for postoperative management in the obstetric population...
January 10, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28054356/impact-of-a-peri-operative-quality-improvement-programme-on-postoperative-pulmonary-complications
#5
J A Moore, D H Conway, N Thomas, D Cummings, D Atkinson
Postoperative pulmonary complications are common, with a reported incidence of 2-40%, and are associated with adverse outcomes that include death, longer hospital stay and reduced long-term survival. Enhanced recovery is now a standard of care for patients undergoing elective major surgery. Despite the high prevalence of pulmonary complications in this population, few elements of enhanced recovery specifically address reducing these complications. In 2013, a prevalence audit confirmed a postoperative pulmonary complication rate of 16/83 (19...
January 4, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28052313/thromboelastography-teg-or-rotational-thromboelastometry-rotem-to-monitor-haemostatic-treatment-in-bleeding-patients-a-systematic-review-with-meta-analysis-and-trial-sequential-analysis
#6
REVIEW
A Wikkelsø, J Wetterslev, A M Møller, A Afshari
Coagulopathy and severe bleeding are associated with high mortality. We evaluated haemostatic treatment guided by the functional viscoelastic haemostatic assays, thromboelastography or rotational thromboelastometry in bleeding patients. We searched for randomised, controlled trials irrespective of publication status, publication date, blinding status, outcomes published or language from date of inception to 5 January 2016 in six bibliographic databases. We included 17 trials (1493 participants), most involving cardiac surgery...
January 4, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28045209/aagbi-safer-pre-hospital-anaesthesia-2017-association-of-anaesthetists-of-great-britain-and-ireland
#7
LETTER
D J Lockey, K Crewdson, G Davies, B Jenkins, J Klein, C Laird, P F Mahoney, J Nolan, A Pountney, S Shinde, S Tighe, M Q Russell, J Price, C Wright
Pre-hospital emergency anaesthesia with oral tracheal intubation is the technique of choice for trauma patients who cannot maintain their airway or achieve adequate ventilation. It should be carried out as soon as safely possible, and performed to the same standards as in-hospital emergency anaesthesia. It should only be conducted within organisations with comprehensive clinical governance arrangements. Techniques should be straightforward, reproducible, as simple as possible and supported by the use of checklists...
January 3, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28035681/credible-control-groups-and-blinding
#8
S W Choi, D M H Lam
No abstract text is available yet for this article.
December 30, 2016: Anaesthesia
https://www.readbyqxmd.com/read/28035669/a-randomised-controlled-trial-comparing-transnasal-humidified-rapid-insufflation-ventilatory-exchange-thrive-pre-oxygenation-with-facemask-pre-oxygenation-in-patients-undergoing-rapid-sequence-induction-of-anaesthesia
#9
F Mir, A Patel, R Iqbal, M Cecconi, S A R Nouraei
Pre-oxygenation is an essential part of rapid sequence induction of general anaesthesia for emergency surgery, in order to increase the oxygen reservoir in the lungs. We performed a randomised controlled trial of transnasal humidified rapid insufflation ventilatory exchange (THRIVE) pre-oxygenation or facemask pre-oxygenation in patients undergoing emergency surgery. Twenty patients were allocated to each group. No patient developed arterial oxygen saturation < 90% during attempted tracheal intubation. Arterial blood gases were sampled from an arterial catheter immediately after intubation...
December 30, 2016: Anaesthesia
https://www.readbyqxmd.com/read/28032332/deprescribing-implications-for-the-anaesthetist
#10
EDITORIAL
J Hermanowski, N Levy, P Mills, N Penfold
No abstract text is available yet for this article.
December 29, 2016: Anaesthesia
https://www.readbyqxmd.com/read/28026862/evaluation-of-the-accuracy-of-common-weight-estimation-formulae-in-a-zambian-paediatric-surgical-population
#11
L Bowen, M Zyambo, D Snell, J Kinnear, M D Bould
Limited resources and access to healthcare in sub-Saharan Africa are associated with high rates of malnourished children, although many countries globally are demonstrating increasing childhood obesity. This study evaluated how well current age- or height-based formulae estimate the weight of children undergoing surgery in Zambia. All children under 14 years of age presenting for elective surgery at the University Teaching Hospital, Lusaka, had both height and weight measured. Their actual weight was compared against estimated weight from various formulae...
December 27, 2016: Anaesthesia
https://www.readbyqxmd.com/read/27996086/international-consensus-statement-on-the-peri-operative-management-of-anaemia-and-iron-deficiency
#12
M Muñoz, A G Acheson, M Auerbach, M Besser, O Habler, H Kehlet, G M Liumbruno, S Lasocki, P Meybohm, R Rao Baikady, T Richards, A Shander, C So-Osman, D R Spahn, A A Klein
Despite current recommendations on the management of pre-operative anaemia, there is no pragmatic guidance for the diagnosis and management of anaemia and iron deficiency in surgical patients. A number of experienced researchers and clinicians took part in an expert workshop and developed the following consensus statement. After presentation of our own research data and local policies and procedures, appropriate relevant literature was reviewed and discussed. We developed a series of best-practice and evidence-based statements to advise on patient care with respect to anaemia and iron deficiency in the peri-operative period...
December 20, 2016: Anaesthesia
https://www.readbyqxmd.com/read/27995626/difficult-tracheal-tube-passage-and-subglottic-airway-injury-during-intubation-with-the-glidescope-%C3%A2-videolaryngoscope-a-randomised-controlled-comparison-of-three-tracheal-tubes
#13
K Su, X Gao, F-S Xue, G-N Ding, Y Zhang, M Tian
Difficulty during placement of the tracheal tube is a known problem when intubating with the GlideScope(®) , which may lead to subglottic airway injury. This randomised, controlled clinical trial was designed to compare the resistance to passage of PVC (polyvinyl chloride), reinforced or BlockBuster tracheal tubes during intubation with the GlideScope. Secondary outcomes included the time taken to intubate and assessment of subglottic airway injury. One-hundred and seventy-seven patients were included in the data analysis...
December 20, 2016: Anaesthesia
https://www.readbyqxmd.com/read/27987229/neuronal-damage-biomarkers-in-the-identification-of-patients-at-risk-of-long-term-postoperative-cognitive-dysfunction-after-cardiac-surgery
#14
W F Kok, J Koerts, O Tucha, T W L Scheeren, A R Absalom
Biomarkers of neurological injury can potentially predict postoperative cognitive dysfunction. We aimed to identify whether classical neuronal damage-specific biomarkers, including brain fatty acid-binding protein, neuron-specific enolase and S100 calcium-binding protein β, as well as plasma-free haemoglobin concentration as a measure of haemolysis, could be used to predict the risk of long-term cognitive decline after coronary artery bypass grafting with or without cardiopulmonary bypass. We assessed cognitive function using the CogState brief computerised cognitive test battery at 3 months and at 15 months after surgery...
December 17, 2016: Anaesthesia
https://www.readbyqxmd.com/read/27987218/the-effects-of-tracheal-tube-cuffs-filled-with-air-saline-or-alkalinised-lidocaine-on-haemodynamic-changes-and-laryngotracheal-morbidity-in-children-a-randomised-controlled-trial
#15
S M F Soares, V M Arantes, M P Módolo, V J B Dos Santos, L A Vane, L H Navarro E Lima, L G Braz, P do Nascimento, N S P Módolo
We studied the effects of tracheal tube cuffs filled with air, saline or alkalinised lidocaine on haemodynamic changes during tracheal extubation and postoperative laryngotracheal morbidity in children. We randomly allocated 164 children aged 3-13 years undergoing general anaesthesia to one of four groups; tracheal tube cuffs filled with air (n = 41); saline (n = 41); alkalinised lidocaine 0.5% (n = 41); or alkalinised lidocaine 1% (n = 41). Intracuff pressure was monitored and maintained below 20 cmH2 O. The mean (SD) increases in systolic blood pressure after tracheal extubation compared with before extubation were 10...
December 17, 2016: Anaesthesia
https://www.readbyqxmd.com/read/27981565/a-multicentre-snapshot-study-of-the-incidence-of-serious-procedural-complications-secondary-to-central-venous-catheterisation
#16
R K Lathey, R E Jackson, A Bodenham, D Harper, V Patle
Despite the high number of central venous access devices inserted annually, there are limited data on the incidence of the associated procedural complications, many of which carry substantial clinical risk. This point was highlighted in the recently published Association of Anaesthetists of Great Britain and Ireland 'Safe vascular access 2016' guidelines. This trainee-led snapshot study aimed to identify the number of central venous catheter insertions and the incidence of serious complications across multiple hospital sites within a fixed two-week period...
December 16, 2016: Anaesthesia
https://www.readbyqxmd.com/read/27928821/the-universal-anaesthesia-machine-uam-assessment-of-a-new-anaesthesia-workstation-built-with-global-health-in-mind
#17
D A H de Beer, F D Nesbitt, G T Bell, A Rapuleng
The Universal Anaesthesia Machine has been developed as a complete anaesthesia workstation for use in low- and middle-income countries, where the provision of safe general anaesthesia is often compromised by unreliable supply of electricity and anaesthetic gases. We performed a functional and clinical assessment of this anaesthetic machine, with particular reference to novel features and functioning in the intended environment. The Universal Anaesthesia Machine was found to be reliable, safe and consistent across a range of tests during targeted functional testing...
December 8, 2016: Anaesthesia
https://www.readbyqxmd.com/read/27928826/a-feasibility-study-of-awake-videolaryngoscope-assisted-intubation-in-patients-with-periglottic-tumour-using-the-channelled-king-vision-%C3%A2-videolaryngoscope
#18
L Markova, T Stopar-Pintaric, T Luzar, J Benedik, I Hodzovic
Airway management in patients with periglottic tumour is a high-risk procedure with potentially serious consequences. There is no consensus on how best to secure the airway in this group of patients. We conducted a feasibility study of awake tracheal intubation using a King Vision(®) videolaryngoscope with a channelled blade in a cohort of 25 patients, with a periglottic tumour requiring diagnostic or radical surgery. We used 10% and 4% lidocaine to topicalise the airway and midazolam and remifentanil for sedation...
December 7, 2016: Anaesthesia
https://www.readbyqxmd.com/read/27910094/the-obstetric-difficult-airway-if-we-can-t-predict-it-can-we-prevent-it
#19
EDITORIAL
T Girard, A Palanisamy
No abstract text is available yet for this article.
December 2, 2016: Anaesthesia
https://www.readbyqxmd.com/read/27897312/the-feasibility-of-micro-ultrasound-as-a-tool-to-image-peripheral-nerves
#20
A Chandra, R Eisma, P Felts, S Munirama, G A Corner, C E M Demore, G McLeod
Despite widespread use of ultrasound imaging to guide needle placement, the incidence of transient and permanent nerve damage as a complication of regional anaesthesia has not changed over the last decade. In view of the controversy surrounding intraneural injection there is a need to understand the structural changes caused by subepineural and subperineural needle penetration. Clinical ultrasound machines do not provide adequate anatomical resolution, and anaesthetists have difficulty judging the precise location of the needle tip relative to the epineurium...
November 29, 2016: Anaesthesia
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