European journal of anaesthesiology
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Randomized Controlled Trial Observational Study
Best position and depth of anaesthesia for laryngeal mask airway removal in children: A prospective randomised controlled trial.
This controlled study randomised 212 children to either deep plane-of-anesthesia or awake, and either supine or lateral position, for removal of their laryngeal mask at the completion of surgery.
"Deep anesthesia" was defined as ET-sevoflurane 2.2%, stable for 1 minute. The "awake" group had their LMA removed by the PACU nurse after eye opening and/or obeying commands.
Airway complications included desaturation < 90%, stridor, laryngospasm, retching/vomiting, excess secretions and biting. A secondary outcome was also studied, assigning a 'clinical significance score' to the range of complications.
Deep removal in the lateral position was associated with the fewest complications. Deep removal when supine was associated with the most complications.
This study was a follow-up to a two-centre observational audit from 2008.
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The transversus abdominis plane block has become popular since it has been combined with ultrasound-guided techniques. In abdominal surgery, and especially in subumbilical surgery, it improves postoperative analgesia and reduces morphine consumption. Although it has been shown to be an effective technique, there are wide variations in reported doses and volumes of local anaesthetic used. ⋯ The ED50 of ropivacaine in TAP blocks in reversal of ileostomy is close to the toxic threshold. Anaesthesiologists should always be aware of the systemic toxicity risk and use weight-based doses when performing a TAP block.
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Randomized Controlled Trial
Simulation-based training in flexible fibreoptic intubation: A randomised study.
Flexible fibreoptic intubation (FOI) is a key element in difficult airway management. Training of FOI skills is an important part of the anaesthesiology curriculum. Simulation-based training has been shown to be effective when learning FOI, but the optimal structure of the training is debated. The aspect of dividing the training into segments (part-task training) or assembling into one piece (whole-task training) has not been studied. ⋯ Part-task training did not prove more effective than whole-task training when training novices in FOI skills. FOI is very suitable for simulation-based training and segmentation of the procedure during training is not necessary.
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Letter Randomized Controlled Trial
Real-time needle-tracking ultrasound facilitates needle placement in a phantom gel model: A prospective randomised crossover trial.
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Observational Study
Mini-fluid challenge predicts fluid responsiveness during spontaneous breathing under spinal anaesthesia: an observational study.
The ability to predict fluid responsiveness in spontaneously breathing patients under spinal anaesthesia is desirable. ⋯ ΔSV100 greater than 7% accurately predicted fluid responsiveness during surgery with a grey zone ranging between 3 and 8%.