European journal of anaesthesiology
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Clinical Trial
Evaluation of the Bonfils intubating fibrescope for predicted difficult intubation in awake patients with ear, nose and throat cancer.
Anaesthesiologists are regularly faced with difficult tracheal intubation. The objective of the study was to evaluate the feasibility and tolerability of tracheal intubation with the Bonfils intubating fibrescope in awake adult patients with predicted difficult intubation undergoing cancer surgery in an ear, nose and throat unit. ⋯ NCT01070537, URL: http://clinicaltrials.gov/ct2/show/NCT01070537?term=bonfils&rank=2.
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Volatile anaesthetic agents have been used in millions of patients around the world and have proved to be both well tolerated and efficient. In recent years, cardioprotective properties of these drugs have been demonstrated unequivocally in numerous experimental investigations, but the beneficial effects of volatile anaesthetics in daily clinical practice are still under debate. In order to elucidate their cardioprotective properties in an unbiased way, the STAIR (Stroke Therapy Academic Industry Roundtable Preclinical Recommendation) criteria proposed as a framework for researchers in the field of neuroprotection can be applied to research conducted in the field of cardioprotection by volatile anaesthetics. ⋯ Specifically, a dose-response pattern has been found with a minimal alveolar concentration value and a ceiling effect; volatile anaesthetics show two distinct therapeutic windows after application; important outcome measures such as hospital length of stay have been addressed; and multiple species have been studied by different independent groups of researchers who were largely able to reproduce their findings. Given the numerous confounding factors capable of attenuating or even abolishing the cardioprotective properties of volatile anaesthetics in laboratory investigations, the positive effects found in the majority of clinical trials point to the fact that the cardioprotective effects exerted by volatile anaesthetics are robust and triggered by interactions with several distinct cellular and subcellular targets, thereby providing multiplication and reiteration. The available evidence indicates that volatile anaesthetic agents should be used routinely in clinical practice in order to claim an extra benefit for our patients 'free of charge'.
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The intraoperative infusion of isotonic solutions with 1-2.5% glucose in children is considered well established use in Europe and other countries. Unfortunately, a European marketing authorisation of such a solution is currently missing and as a consequence paediatric anaesthetists tend to use suboptimal intravenous fluid strategies that may lead to serious morbidity and even mortality because of iatrogenic hyponatraemia, hyperglycaemia or medical errors. ⋯ As a result, it was recommended that an intraoperative fluid should have an osmolarity close to the physiologic range in children in order to avoid hyponatraemia, an addition of 1-2.5% instead of 5% glucose in order to avoid hypoglycaemia, lipolysis or hyperglycaemia and should also include metabolic anions (i.e. acetate, lactate or malate) as bicarbonate precursors to prevent hyperchloraemic acidosis. Thus, the underlying intention of this consensus statement is to facilitate the granting of a European marketing authorisation for such a solution with the ultimate goal of improving the safety and effectiveness of intraoperative fluid therapy in children.