European journal of anaesthesiology
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Randomized Controlled Trial Comparative Study
A comparison of the Laryngopharyngeal Examination blade and the English Macintosh laryngoscope blade using an intubating manikin: a prospective randomized crossover study.
To compare the new design laryngoscope blade, Laryngopharyngeal Examination blade, with the English Macintosh blade for examination of the laryngopharynx and placement of a nasogastric tube in the presence of a tracheal tube, time taken to insert the nasogastric tube and for tracheal intubation in an adult intubation manikin. ⋯ We conclude that, in a manikin, the new design blade can make nasogastric tube insertion easier when compared with the Macintosh blade and it can be used to facilitate laryngoscopy and tracheal intubation. Further studies are needed to evaluate its use in patients.
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Awake craniotomy has become an increasingly frequent procedure. In this paper, the principles of its anaesthetic management are reviewed. The means allowing achievement of anaesthetic objectives are described, with emphasis on points that determine success of the procedure. ⋯ The main challenge of intraoperative anaesthetic management relies on the ability of rapidly adjusting the level of sedation and analgesia according to the sequence of surgical events, while ensuring haemodynamic stability, adequate ventilation, and minimal interference with eventual electrophysiological recordings. Throughout the procedure, complications must be anticipated and managed according to predefined guidelines. More prospective randomized clinical trials are still needed to improve safety and efficacy of awake craniotomies, as well as to validate this technique in comparison with more conventional anaesthetic management.
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Randomized Controlled Trial Comparative Study
A comparison between target-controlled and manually controlled propofol infusions in patients undergoing routine surgical procedures.
Previous studies have shown that target-controlled infusion (TCI) was associated with increased propofol consumption as compared with manually controlled infusion (MCI). However, most studies lacked an objective measurement of anaesthetic depth. We compared TCI and MCI with regard to propofol dose requirement while monitoring depth of anaesthesia with bispectral index (BIS) and midlatency auditory-evoked potentials (MLAEPs). ⋯ Anaesthesia significantly increased latency of Pa and Nb compared with when patients were awake (P < 0.01). After extubation, the latency of Pa and Nb significantly decreased and basically returned to baseline level. BIS and latency of both Pa and Nb did not differ between groups.Also, the propofol induction dose (mean WSD: TCI, 2.09 +/- 0.36 mg kg(-1); MCI, 2.06 +/- 0.16 mg kg(-1) and total dose (TCI, 5.57 +/- 0.96 mg kg(-1) h(-1); MCI, 5.79 +/- 0.87 mg kg(-1) h(-1) and measured plasma propofol concentration during anaesthesia did not differ between groups. At 15 min after intubation, the mean predicted plasma concentration (2.2 +/- 0.2 microg ml(-1)) differed significantly from the measured plasma concentration (2.8 +/- 1.2 microg ml(-1)). No correlation was observed between predicted and measured propofol plasma concentrations.
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Comparative Study
Performance of SAPS3, compared with APACHE II and SOFA, to predict hospital mortality in a general ICU in Southern Europe.
Simplified Acute Physiology Score (SAPS3) has not been validated in Southern European countries. The purpose of this study was to validate the ability of SAPS3 to predict hospital mortality in adult patients in an interdisciplinary intensive care unit in Southern Europe, compared with Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA). ⋯ Our data demonstrate a better calibration of SAPS3 than APACHE II. Calibration was sufficient only for SAPS3. Hospital mortality was lower than predicted by both models. The discrimination of SAPS3 is excellent, and, when it is customized for Southern Europe, SAPS3 accurately predicts mortality risk in our adult mixed-case ICU.
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Controlled Clinical Trial
Diastolic function: the influence of pneumoperitoneum and Trendelenburg positioning during laparoscopic hysterectomy.
Several reports concerning the haemodynamic changes during gynaecologic laparoscopy have been published so far, and the effects of head-down tilt and pneumoperitoneum have not been clearly separated. However, its main effect seems to be an increase in systemic vascular resistance. We investigated how the augmented afterload can affect diastolic function. ⋯ We have found that pneumoperitoneum has important effects on left ventricular volumes, causing a drop in left ventricular end-diastolic volume; it also affects diastolic function with a delay in deceleration time and isovolumetric relaxation time without any effects on intracavitary pressures.