European journal of anaesthesiology
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We hypothesised that head and neck position could affect the effectiveness of ventilation with the i-gel airway. To test this hypothesis, we investigated the influence of different head and neck positions on oropharyngeal sealing pressures and ventilation scores during ventilation with i-gel. ⋯ Effective ventilation with an i-gel can be performed in patients in whom the head and neck is extended or rotated, whereas flexion of the head and neck adversely affects ventilation. Clinically, flexion of the head and neck should be avoided during ventilation with the i-gel.
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Propofol, which is the most commonly used drug for induction of general anaesthesia, has also become a popular drug for procedural sedation. Because its use may be associated with serious and potentially fatal side-effects, the manufacturers of propofol restrict its use solely to personnel trained in general anaesthesia. In spite of this warning, the use of propofol for procedural sedation by non-anaesthesiologists is rapidly expanding in many countries. ⋯ At about the same time, the European Society of Anaesthesiology (ESA), together with various European gastroenterology societies, published new guidelines entitled 'Non-anaesthesiologist Administration of Propofol for Gastrointestinal Endoscopy' (NAAP). Following publication of the NAAP guidelines, many reservations have been expressed by ESA member societies and individuals, dealing with professional, political, procedural and safety-oriented concerns. Out of concern for patient safety, and in order to officially and publicly dissociate themselves from the NAAP guidelines, 21 national societies of anaesthesiology in Europe, all of whom are ESA members, have signed a Consensus Statement confirming that due to its significant well known risks, propofol should be administered only by those trained in the administration of general anaesthesia.
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Letter Case Reports
Bilateral postoperative brachial plexus palsy and longlasting surgery.
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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.