European journal of anaesthesiology
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The anaesthesiologist's preoperative interview with the patient is important in preparing the patient for surgery. Its potential protective influence on adverse side-effects from anaesthesia and convalescence is rarely investigated within the context of other perioperative factors. Structural equation modelling allows detection and quantification of all causal relationships and mediator effects in multivariate models. Therefore, this method is presented as a tool and applied to discover the influence of the preoperative interview within socio-demographic variables and duration of surgery on complaints and recovery after anaesthesia. ⋯ The anaesthesiologist's efforts to improve the interview with the patient by more reassuring and proper information will result in less side-effects from anaesthesia and better recovery from surgery. It could be demonstrated that structural equation modelling is a powerful tool for detection of causal relationships and mediator effects in perioperative medicine.
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Comparative Study
Low-dose combined spinal-epidural anaesthesia vs. conventional epidural anaesthesia for Caesarean section in pre-eclampsia: a retrospective analysis.
Epidural anaesthesia is the preferred technique of anaesthesia for Caesarean section in pre-eclampsia. Spinal anaesthesia is considered by some as a safe and effective alternative, which is especially useful in emergency situations. Combined spinal-epidural anaesthesia, using low doses of local anaesthetics with opioids, is effective and reduces the incidence of hypotension in normal pregnancy. We performed a retrospective chart analysis to evaluate the effects of combined spinal-epidural anaesthesia on maternal haemodynamics and fetal outcome compared to conventional epidural anaesthesia. ⋯ Combined spinal-epidural anaesthesia appears to be safe as anaesthetic technique for pre-eclampsia and severe pre-eclampsia. However, it is important to consider the retrospective design of the study and the large number of epidural anaesthetics performed.
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One of the complications of laparoscopic surgery is carbon monoxide production during electrocautery. The aim of our study was to ascertain the relationship between intraperitoneal and alveolar concentrations of carbon monoxide and systemic carboxyhaemoglobin in patients undergoing laparoscopic cholecystectomy and anaesthetized with a closed system, where the carbon monoxide excreted through the lungs is accumulated in the circuit and thus re-inhaled. ⋯ No significant increase in carboxyhaemoglobin is produced during laparoscopic surgery, even under closed-system anaesthesia without pulmonary carbon monoxide elimination. This is most likely due to a low peritoneal absorption of carbon monoxide. We conclude that in adult patients, no carbon monoxide intoxication is caused if reasonable periods of electrocautery are used and the intraperitoneal gas is regularly renewed.
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Former studies revealed conflicting information on the usefulness of intraoperative monitoring of visual evoked potentials. This study was designed to evaluate the characteristics of visual evoked potential recording in surgically anaesthetized patients using the modality of steady-state visual evoked potentials. ⋯ We conclude from this study, that steady-state visual evoked potential recordings in the surgically anaesthetized patient appeared to be more stable compared to our earlier findings using transient visual evoked potentials. However, further efforts are necessary to improve the stability of the recordings during surgery and thus allow for a more reliable intraoperative monitoring of visual pathways in routine clinical practice.
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Only regular training of anaesthetic personnel ensures safe and reliable application of cricoid pressure during rapid sequence induction of anaesthesia. Previously described training devices are either complicated, too expensive and usually unavailable, or they are very simple and do not correctly simulate the process of applying cricoid force. We designed and tested a cricoid pressure trainer with real-time display of applied force. The device is easy to assemble at relatively little cost with material widely available. It allows effective biofeedback training of the force required during the Sellick manoeuvre and can be used for routine staff assessment. ⋯ Our biofeedback cricoid pressure trainer is effective in the assessment and training of correct cricoid pressure application by anaesthetic personnel.