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Anaesthesia

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https://www.readbyqxmd.com/read/28418067/a-case-series-of-vital-signs-controlled-patient-assisted-intravenous-analgesia-vpia-using-remifentanil-for-labour-and-delivery
#1
W L Leong, B L Sng, Q Zhang, N L R Han, R Sultana, A T H Sia
Intravenous remifentanil patient-controlled analgesia can be used during labour as an alternative to epidural analgesia. Adverse effects of opioids, including hypoxia and bradycardia, may lead to maternal morbidity and mortality. We devised an interactive feedback system based on a clinical proportional algorithm, to continuously monitor for adverse effects to enhance safety and better titrate analgesia. This vital signs-controlled, patient-assisted intravenous analgesia with remifentanil used a prototype delivery system linked to a pulse oximeter that evaluated maternal oxygen saturation and heart rate continuously...
April 18, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28419420/reliability-of-pressure-waveform-analysis-to-determine-correct-epidural-needle-placement-in-labouring-women
#2
I Al-Aamri, S H Derzi, A Moore, M F Elgueta, M Moustafa, T Schricker, D Q Tran
Pressure waveform analysis provides a reliable confirmatory adjunct to the loss-of-resistance technique to identify the epidural space during thoracic epidural anaesthesia, but its role remains controversial in lumbar epidural analgesia during labour. We performed an observational study in 100 labouring women of the sensitivity and specificity of waveform analysis to determine the correct location of the epidural needle. After obtaining loss-of-resistance, the anaesthetist injected 5 ml saline through the epidural needle (accounting for the volume already used in the loss-of-resistance)...
April 17, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28419411/pressure-waveforms-to-assess-epidural-placement-is-there-a-role-on-delivery-suite
#3
EDITORIAL
R A McKendry, N A Muchatuta
No abstract text is available yet for this article.
April 17, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28407211/long-term-alterations-in-monocyte-function-after-elective-cardiac-surgery
#4
M Zawadka, J Wahome, H Oszkiel, W Y Szeto, B Cobb, K Laudanski
Optimal immunological homoeostasis determines the long-term recovery of patients in the postoperative period. The functional adaptability of monocytes plays a pivotal role in adjusting the host's response to an insult, immunostasis and long-term health, and may help to determine successful recovery. We undertook a longitudinal analysis of the functional adaptability of monocytes in 20 patients undergoing heart surgery with cardiopulmonary bypass, as a model of severe stress. Using each patient's pre-cardiopulmonary bypass data as a baseline, we investigated the characteristics of peripheral blood monocytes' functional plasticity in-vitro before elective bypass, and three months afterwards...
April 13, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28401537/effect-of-prophylactic-placement-of-internal-iliac-artery-balloon-catheters-on-outcomes-of-women-with-placenta-accreta-an-impact-study
#5
S Feng, Z Liao, H Huang
We performed an impact study on the introduction of routine placement of internal iliac artery balloon catheters for the management of haemorrhage during caesarean section in women with placenta accreta. We identified 11 women, with prenatally diagnosed placenta accreta/increta/percreta before this change in practice, who acted as controls, and 30 women who had iliac artery balloons placed. The balloons were inflated in 27 cases. The median (IQR [range]) intra-operative blood loss was 1100 (800-2600 [500-6000]) ml in controls, compared with 1000 (600-2513 [400-15000]) ml in women with iliac artery balloons (p = 0...
April 12, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28394040/pain-related-unscheduled-contact-with-healthcare-services-after-outpatient-surgery
#6
L D Brix, K T Bjørnholdt, T M Thillemann, L Nikolajsen
This prospective, observational study explored the need for pain-related unscheduled contact with healthcare services after outpatient surgery. We hypothesised that 10% of outpatients would have pain-related unscheduled contact with healthcare services, and that the incidence would differ depending on the type of surgical procedure. In total, 905 patients who had undergone one of five common outpatient surgical procedures (knee or shoulder arthroscopy, surgical correction of hallux valgus, laparoscopic cholecystectomy or laparoscopic gynaecological procedures) completed an electronic questionnaire one week and eight weeks after surgery...
April 10, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28390061/should-patients-be-advised-not-to-drive-for-4%C3%A2-days-after-isoflurane-anaesthesia
#7
EDITORIAL
L M Powell, M Molyneux
No abstract text is available yet for this article.
April 8, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28382661/pre-operative-haemoglobin-levels-and-iron-status-in-a-large-multicentre-cohort-of-patients-undergoing-major-elective-surgery
#8
M Muñoz, M J Laso-Morales, S Gómez-Ramírez, M Cadellas, M J Núñez-Matas, J A García-Erce
Pre-operative anaemia in patients undergoing major surgical procedures has been linked to poor outcomes. Therefore, early detection and treatment of pre-operative anaemia is recommended. However, to effectively implement a pre-operative anaemia management protocol, an estimation of its prevalence and main causes is needed. We analysed data from 3342 patients (44.5% female) scheduled for either: elective orthopaedic surgery (n = 1286); cardiac surgery (n = 691); colorectal cancer resection (n = 735); radical prostatectomy (n = 362); gynaecological surgery (n = 203) or resection of liver metastases (n = 122)...
April 6, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28382653/diagnostic-criteria-for-pre-operative-anaemia-time-to-end-sex-discrimination
#9
EDITORIAL
A Butcher, T Richards, S J Stanworh, A A Klein
No abstract text is available yet for this article.
April 6, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28369690/disease-coding-for-anaesthetic-and-peri-operative-practice-an-opportunity-not-to-be-missed
#10
EDITORIAL
J H MacG Palmer, M R J Sury, T M Cook, J J Pandit
No abstract text is available yet for this article.
April 1, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28337769/accuracy-intra-and-inter-rater-reliability-of-three-scoring-systems-for-the-glottic-view-at-videolaryngoscopy
#11
E J O'Loughlin, A D Swann, J D English, R Ramadas
An accurate and reproducible recording of laryngoscopic view at tracheal intubation is an important aspect of anaesthetic practice. Unlike direct laryngoscopy, in which the view achieved by the line of sight directly relates to the ease of intubating the trachea, videolaryngoscopy can create a situation in which the view is good, but intubation difficult or impossible. Communicating this to a subsequent anaesthetist is important. We compared three scoring systems: Cormack and Lehane; POGO (percentage of glottic opening); and the Fremantle score, as used by 74 critical care doctors rating 30 anonymised videos of videolaryngoscopic intubations...
March 24, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28332186/a-pilot-study-of-ultrasound-evaluation-of-gastric-emptying-in-patients-with-end-stage-renal-failure-a-comparison-with-healthy-controls
#12
C Chen, L Liu, C Y Wang, S-W Choi, V M Yuen
This prospective study was designed to evaluate gastric volume and content in patients with renal failure and healthy controls after an overnight fast, immediately after a light meal and at 6 h after the meal. Thirty subjects in each group were recruited. At each scanning session, gastric antral cross-sectional area was measured in the supine recumbent and right lateral decubitus positions, and a qualitative assessment of gastric contents was made using the Perlas three-point grading system. Six hours after the meal, the mean (SD) antral cross-sectional area in the supine position was 471 (195) mm(2) in patients with renal failure and 319 (106) mm(2) in healthy controls (p = 0...
March 23, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28321836/intra-oral-ignition-of-monopolar-diathermy-during-transnasal-humidified-rapid-insufflation-ventilatory-exchange-thrive
#13
D Onwochei, K El-Boghdadly, R Oakley, I Ahmad
We present the case of unanticipated airway ignition during hard palate biopsy. Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) and monopolar diathermy were utilised for the procedure, during which an arc arose from the diathermy tip to a titanium implant, causing a brief ignition on the monopolar diathermy grip. This case highlights the need for maintained awareness of fire risk when using diathermy in the presence of THRIVE during airway surgery.
March 20, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28317096/the-use-of-enrichment-to-reduce-statistically-indeterminate-or-negative-trials-in-critical-care
#14
EDITORIAL
M Shankar-Hari, G D Rubenfeld
No abstract text is available yet for this article.
March 20, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28317094/long-term-outcomes-and-cost-effectiveness-of-high-dose-dexamethasone-for-cardiac-surgery-a-randomised-trial
#15
J M Dieleman, G A de Wit, A P Nierich, P M Rosseel, J M van der Maaten, J Hofland, J C Diephuis, F de Lange, C Boer, R E Neslo, K G Moons, L A van Herwerden, J G Tijssen, C J Kalkman, D van Dijk
Prophylactic intra-operative administration of dexamethasone may improve short-term clinical outcomes in cardiac surgical patients. The purpose of this study was to evaluate long-term clinical outcomes and cost effectiveness of dexamethasone versus placebo. Patients included in the multicentre, randomised, double-blind, placebo-controlled DExamethasone for Cardiac Surgery (DECS) trial were followed up for 12 months after their cardiac surgical procedure. In the DECS trial, patients received a single intra-operative dose of dexamethasone 1 mg...
March 20, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28295147/a-prospective-randomised-trial-of-pre-oxygenation-strategies-available-in-the-pre-hospital-environment
#16
C J Groombridge, E Ley, M Miller, T Konig
Pre-oxygenation before tracheal intubation aims to increase safe apnoea duration by denitrogenation of the functional residual capacity of the lungs, and increasing oxygen stores at the onset of apnoea. Pre-oxygenation options in the pre-hospital environment are limited due to oxygen availability and equipment portability. The aim of this study was to evaluate the effectiveness of strategies available in this setting. This was a prospective, randomised, crossover study of 30 healthy volunteers who underwent 3-min periods of pre-oxygenation by tidal volume breathing with a non-rebreather mask, a bag-valve-mask and a portable ventilator...
March 14, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28294285/evaluation-of-a-flexible-bronchoscope-prototype-designed-for-bronchoscopy-during-mechanical-ventilation-a-proof-of-concept-study
#17
M-A Nay, A Auvet, J Mankikian, V Herve, P-F Dequin, A Guillon
Bronchoscopy during mechanical ventilation of patients' lungs significantly affects ventilation because of partial obstruction of the tracheal tube, and may thus be omitted in the most severely ill patients. It has not previously been possible to reduce the external diameter of the bronchoscope without reducing the diameter of the suction channel, thus reducing the suctioning capacity of the device. We believed that a better-designed bronchoscope could improve the safety of bronchoscopy in patients whose lungs were ventilated...
March 14, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28272748/sevoflurane-induced-isoelectric-eeg-and-burst-suppression-differential-and-antagonistic-effect-of-added-nitrous-oxide
#18
B Niu, J Y Xiao, Y Fang, B Y Zhou, J Li, F Cao, Y K Tian, W Mei
The objective of this study was to investigate whether nitrous oxide influenced the ED50 of sevoflurane for induction of isoelectric electroencephalogram (ED50isoelectric ) differently from its influence on the ED50 of sevoflurane for electroencephalogram burst suppression (ED50burst ). In a prospective, randomised, double-blind, parallel group, up-down sequential allocation study, 77 ASA physical status 1 and 2 patients received sevoflurane induction and, after tracheal intubation, were randomly allocated to receive sevoflurane with either 40% oxygen in air (control group) or 60% nitrous oxide in oxygen mixture (nitrous group)...
March 8, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28272745/when-anaesthetics-collide-antagonism-of-one-agent-by-another
#19
EDITORIAL
J J Pandit
No abstract text is available yet for this article.
March 8, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28251618/a-randomised-crossover-simulation-study-comparing-the-impact-of-chemical-biological-radiological-or-nuclear-substance-personal-protection-equipment-on-the-performance-of-advanced-life-support-interventions
#20
J Schumacher, J Arlidge, F Garnham, I Ahmad
Recent incidents involving chemical, biological, radiological and nuclear substances have stressed the importance of sufficient personal protection equipment for medical first-responders. Modern lightweight, battery-independent, suit ensembles may prove superior to the current protective suit used in the UK. This study compared the powered respiratory protective suit (PRPS ensemble) with a lightweight suit consisting of a SARATOGA(®) Multipurpose CBRN Protective Coverall Polyprotect 12 in conjunction with the Avon C50 Respirator/Avon CBRNF12CE filter canister and butyl rubber protective gloves (Polyprotect 12 ensemble)...
March 2, 2017: Anaesthesia
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