European journal of anaesthesiology
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Thoracic epidural anaesthesia (TEA) is increasingly used in high-risk surgical patients. We recently demonstrated that TEA-mediated cardiac sympathicolysis prevents the native right ventricular positive inotropic response to the induction of acute pulmonary hypertension. ⋯ During acute pulmonary hypertension, selective blockade of cardiac sympathetic nerves by TEA acutely abolished the protective adaptation of right ventricular contractility to right ventricular pressure overload and deteriorated systemic haemodynamics. This effect was attributable solely to the depression of right ventricular contractility and was neither the result of impaired right ventricular coronary flow dynamics nor of systemic vasodilation.
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Randomized Controlled Trial
Assessment of subjective workload in an anaesthesia simulator environment: reliability and validity.
For the subjective assessment of workload, Borg's Rating of Perceived Exertion (RPE) scale is a global measure of perceived workload during anaesthesia induction, maintenance and emergence in the real workplace. In the present study, validity and reliability of the RPE scale were analysed for a full-scale simulator environment using scenarios of induction of general anaesthesia with and without critical incidents. ⋯ RPE scores were significantly increased after critical incidents during simulated anaesthesia induction and indicate good construct validity. Reliability may be impaired by the fact that the first session was announced to be without a critical incident. The RPE scale is easy to administer and a valid tool for subjective workload assessment in simulator settings. Reliability is moderate.
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The present article is intended as an update for anaesthesiologists on recent developments in life-threatening paediatric emergencies and paediatric resuscitation. It is assumed that the reader has at least a basic knowledge of the general principles of emergency medicine, such as the ABCDE-approach and the principle of 'treat first what kills first'; and also that the reader is familiar with the anatomical, physiological and psychological differences between adults and children. ⋯ In the second half of the article, the principles of the initial treatment for acute, life-threatening problems in children and paediatric resuscitation are discussed with reference to the recent literature. The article ends with a discussion of the changes in latest guidelines for resuscitation of babies at birth.
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It is important that a surgical list is planned to utilise as much of the scheduled time as possible while not over-running, because this can lead to cancellation of operations. We wished to assess whether, theoretically, the known duration of individual operations could be used quantitatively to predict the likely duration of the operating list. ⋯ A simple quantitative method of estimating operating list duration for a series of operations leads to an algorithm (readily created on an Excel spreadsheet, http://links.lww.com/EJA/A19) that can potentially improve operating list planning.
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Randomized Controlled Trial
Ultrasound-guided infrapatellar nerve block for anterior cruciate ligament repair: a prospective, randomised, double-blind, placebo-controlled clinical trial.
We have previously described an ultrasonography-guided technique to block the infrapatellar nerve that is associated with an extended duration of anaesthesia. The aim of the present study was to investigate the clinical usefulness of this new technique in patients undergoing arthroscopy-assisted anterior cruciate ligament repair. ⋯ Adjunct use of an ultrasound-guided block of the infrapatellar nerve is associated with improved pain relief and an increased number of sleep hours after arthroscopy-assisted anterior cruciate ligament repair.