European journal of anaesthesiology
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Randomized Controlled Trial Comparative Study
Comparison of four facial muscles, orbicularis oculi, corrugator supercilii, masseter or mylohyoid, as best predictor of good conditions for intubation: A randomised blinded trial.
Monitoring of facial muscles after neuromuscular blockade can give an early indication of respiratory muscle readiness for tracheal intubation. ⋯ Following rocuronium 0.6 mg kg at similar depths of anaesthesia, the monitoring of the corrugator supercilii provided the best balance of a shorter onset time while maintaining 'clinically acceptable' intubation conditions.
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Randomized Controlled Trial Comparative Study
The effect of deep vs. awake extubation on respiratory complications in high-risk children undergoing adenotonsillectomy: A randomised controlled trial.
There is ongoing debate regarding the optimal timing for tracheal extubation in children at increased risk of perioperative respiratory adverse events, particularly following adenotonsillectomy. ⋯ There was no difference in the overall incidence of perioperative respiratory adverse events. Both extubation techniques may be used in high-risk children undergoing adenotonsillectomy provided that the child is monitored closely in the postoperative period.
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Anaesthesia management of patients with airway susceptibility remains a challenge in daily clinical practice due to the increased risk of perioperative bronchospasm. Therefore, understanding the mechanisms participating in the interaction between anaesthetic drugs and the lungs is essential in providing the optimal care for patients with chronic lung diseases. Experimental studies performed on various animal models mimicking airway susceptibility have played a key role in understanding the pathogenesis of lung diseases and have characterised the different pathways involved in the altered airway and lung tissue responses to anaesthetic agents. ⋯ Attention is drawn to the significant differences in the pulmonary effects of anaesthetic agents between lungs with normal and those with susceptible airways. Extrapolating clear-cut conclusions from animal research to clinical practices should be made with caution, particularly for muscle relaxants, opioids and local anaesthetics wherein complex pathophysiological mechanisms are responsible for the potential respiratory effects of these agents. Animal models are of great importance in evaluating the potential interaction between anaesthetic drugs and the lungs, in identifying the pathways involved and in targeting preventive or treatment strategies to the lung compartment primarily involved.
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Clinical Trial
Dose of rocuronium for rapid tracheal intubation following remifentanil 2 μg kg-1 and propofol 2 mg kg-1.
Full relaxation is not mandatory for successful tracheal intubation. ⋯ After induction of anaesthesia with remifentanil 2 μg kg and propofol 2 mg kg, the ED50 of rocuronium for acceptable intubation condition was 0.20 mg kg (95% CI, 0.17 to 0.23 mg kg) for rapid sequence intubation. Thus, we recommend that the intubation dose should be 0.8 mg kg.
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Recruitment manoeuvres aim at reversing atelectasis during general anaesthesia but are associated with potential risks such as barotrauma. ⋯ In this ex-vivo model, we found a substantial difference between recruitment and barotrauma pressures using both recruitment strategies. However, a higher margin of safety was obtained when a higher PEEP and lower driving pressure strategy was used for recruiting the lung.